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Sir  William  Osier,  b 


SIR  WILLIAM  OSLEKrBARf: 


1^^S9.0s5 


S\T 


in  tjiE  Citp  of  jaeiti  gork 
CoUege  of  ^Jpsiciansi  anb  burgeons; 


3^ef  erence  Xibrarp 


SIR  WILLIAM  OSLER,  Bart. 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

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http://www.archive.org/details/sirwilliamoslerbOOblog 


William  Osler  in  1906.  ""'"''''^  '^  ''^^^^"'- 


SIR  WILLIAM  OSLER,  Bart. 


tat 


Brief  Tributes  to  His  Personality, 
Influence  and  Public  Service 

Written  by  His  Friends,  Associates  and  Former  Pupils, 

In  Honor  of  His  Seventieth  Birthday  and  First  Published  in  the 

Bulletin  of  The  Johns  Hopkins  Hospital  for  July,  1919 


THE  JOHNS  HOPKINS  PRESS 
BALTIMORE,  MD. 

1920 


Copyright,  1920,  by 
The  Johns  Hopkins  Press 


S<1 


BALTIMORE,    MD.,    U.    8.    A. 


CONTENTS 

PAGE 

Some  Memories  of  the   Development  of  the  Medical   School 

and  of  Osier's  Advent.    By  Henry  M.  Thomas 7 

Osier  as  Chief  of  a  Medical  Clinic.    By  Lewellys  P.  Barker.  .     19 
Some  of  the  Early  Medical  Work  of  Sir  William  Osier.     By 

W.  T.  Councilman 33 

Osier  as  a  Pathologist.    By  William  G.  MacCallum 45 

Osier,  the  Teacher.    By  W.  S.  Thayer 51 

Osier  and  the  Student.    By  Thomas  R.  Brown 55 

Osier  and  Patient.    By  Thomas  McCrae 59 

Osier  and  the  Tuberculosis  Work  of  the  Hospital,     By  Louis 

Hamman   65 

Influence  on  the  Relation  of  Medicine  in  Canada  and  the 

United  States.    By  Thomas  B.  Futcher 69 

Osier  as  a  Citizen  and  His  Relation  to  the  Tuberculosis  Cru- 
sade in  Maryland.    By  Henry  Barton  Jacobs 75 

Osier's  Influence  on  Other  Medical  Schools  in  Baltimore.    His 

Relation  to  the  Medical  Profession.  By  Edward  N.  Brush.     83 
Influence  in  Building  up  the  Medical  and  Chirurgical  Faculty. 

By  Hiram  Woods 89 

Osier  and  the  Book  and  Journal  Club.    By  J.  A.  Chatard 95 

Osier's  Influence  on  the  Library  of  the  Medical  and  Chirurgi- 
cal Faculty  of   the   State  of  Maryland.     By  Marcia  C. 

No  yes,  Librarian 97 

Some  Early  Reminiscences  of  William  Osier.    By  Henry  M. 

Hurd   101 

Osier  as  I  Knew  Him  in  Philadelphia  and  in  the  Hopkins.    By 

Howard  A.  Kelly 107 

Osier  as  a  Bibliophile.    By  Thomas  R.  Boggs Ill 

Osier's  Literary  Style.    By  Edward  N.  Brush 115 

Bibliography.     By  Minnie  Wright  Blogg 121 


SIR  WILLIAM  OSLER,  Bart. 


SOME  MEMORIES  OF  THE  DEVELOPMENT  OF  THE 
MEDICAL  SCHOOL  AND  OF  OSLEE'S  ADVENT 

By  Henry  M.  Thomas 

In  thinking  of  the  early  days  of  The  Johns  Hopkins  Uni- 
versity and  Hospital  and  the  development  of  the  medical 
school,  my  memories  begin  with  the  founder — Johns  Hopkins. 
As  a  small  boy  between  10  and  12  I  sat  on  the  same  bench  with 
Johns  Hopkins  many  Sunday  mornings  at  the  Friends'  Meet- 
ing on  Eutaw  and  Monument  streets.  I  cannot  remember  that 
he  ever  spoke  to  me,  and  I  remember  him  merely  as  a  rather 
unkempt  old  gentleman.  At  that  time  he  had  announced  his 
intentions  for  his  double  bequest,  had,  in  1867,  incorporated 
the  two  institutions  that  were  to  bear  his  name,  had  appointed 
his  trustees,  and  had  bought  the  site  for  the  hospital.  Gallo- 
way Cheston,  the  president  of  the  university  board ;  Francis  T. 
King,  president  of  the  hospital  board ;  Francis  White,  James 
Carey  Thomas,  James  Carey,  and  other  trustees,  were  also 
constant  attendants  at  the  meeting,  and  it  is  pleasant  now  to 
think  that  in  the  congregation  there  were  represented  the 
founder,  his  trustees,  and  the  rising  generation  which  was  to 
be  benefited  by  the  bequests. 

Johns  Hopkins  believed  that  his  wealth  had  been  given  to 
him  for  a  purpose,  and,  to  use  a  Friendly  form  of  speech,  that 
he  would  be  "  given  to  see ''  how  to  dispose  of  it.  He  had  asked 
advice  freely  and  much  had  been  volunteered,  and  many  of  his 
advisers  have  claimed  that  they  suggested  the  objects  of  his 
bequests  and  the  forms  which  they  should  take,  but  I  like  to^ 
think  that  the  wise  instructions  that  he  gave  to  his  trustees 
were  finally  determined  in  meeting.     The  most  important  of 


8  Sir  William  Oslek,  Bart. 

these  for  the  development  of  the  medical  school  was  his  direc- 
tion in  a  letter  to  the  hospital  board,  dated  March  10,  1873, 
that  "  in  all  your  arrangements  in  relation  to  this  hospital  you 
will  bear  constantly  in  mind  that  it  is  my  wish  and  purpose 
that  the  institution  shall  ultimately  form  a  part  of  the  medical 
school  of  that  university  for  which  I  have  made  ample  provi- 
sion by  my  will,^^  so  uniting  forever  the  two  bequests  for  the. 
furtherance  of  medical  education. 

Johns  Hopkins  died  on  December  24,  1873,  and  in  the  early 
part  of  1875  the  trustees  received  the  bequests  and  entered  into 
active  administration  of  the  trusts.  The  first  important  de- 
cision of  the  university  board  was  the  wise  and  fortunate  choice 
of  Daniel  C.  Oilman  as  president  of  the  university.  He  came 
to  Baltimore  May  1,  1875,  and  I  can  remember  well  the  expec- 
tation and  interest  his  coming  aroused.  He  and  his  twoi 
daughters  took  apartments  at  the  old  Mt.  Yernon  Hotel,  and 
for  me  a  delightful  friendship  began. 

Johns  Hopkins  chose  his  trustees  well  and  left  them  un- 
trammeled,  and  they  in  their  turn  gave  President  Gilman  a 
free  hand.  They  had  already  determined  upon  the  establish- 
ment of  a  real  university,  which,  as  Gilman  once  said,  was  to 
supplement  and  not  supplant  existing  institutions.  In  speak- 
ing of  his  first  instructions  which  he  received  from  the  trustees, 
he  says : 

Often  in  private  conversations  and  in  official  interviews,  I  was 
charged  to  hold  up  the  highest  standards,  to  think  of  nothing  but 
the  best  which  was  possible  under  the  limitations  of  the  new 
establishment  in  a  country  where  the  idea  of  a  university  had  not 
been  generally  understood. 

In  furtherance  of  these  objects.  President  Gilman,  in  the 
summer  of  1875,  went  abroad  to  visit  the  various  universities 
and  to  consult  with  the  leaders  in  education.  Medical  educa- 
tion was  much  in  his  mind,  particularly  the  establishment  of 
the  laboratories  and  courses  of  instruction  in  the  fundamental 
sciences  which  would  be  best  fitted  for  the  preliminary  training 
of  medical  students.  The  field  was  almost  entirely  unbroken, 
and  young  men  not  yet  30  were  selected  for  its  cultivation — 


The  Medical  School  and  Osler's  Advent  9 

Rowland  in  physics,  Martin  in  biology,  and  Eemsen  in  chem- 
istry. Rowland,  although  not  then  appointed  to  the  chair  of 
physics,  had  accompanied  Oilman  to  Europe  to  aid  him  in  the 
selection  of  physical  apparatus  and  books.  While  on  this 
journey  he  found  time  to  publish  some  articles  in  the  Philo- 
sophical Magazine  which  Oilman,  with  characteristic  prompt- 
ness and  prophetic  vision,  dated  from  The  Johns  Hopkins 
University — the  first  university  publications. 

Oilman  was  inaugurated  on  February  22,  187G,  and  the 
university  received  students  and  began  instruction  in  the  fall 
of  that  year.  Professor  Huxley,  who  had  taken  much  interest 
in  the  proposed  biological  department,  and  who  had  recom- 
mended a  favorite  pupil  of  his — H.  Newell  Martin — as  its 
director,  was  in  America  and  was  asked  to  give  an  opening 
lecture.  In  this  lecture  he  spoke  of  the  importance  of  bio- 
logical studies,  and  particularly  their  relation  to  a  properly 
organized  medical  course.  My  father,  who  had  selected  me  as 
the  son  most  available  upon  whom  to  experiment  with  this  new 
method  of  medical  education,  saw  to  it  that  I  attended  Oil- 
man's inauguration  and  Huxley's  opening  lecture.  I  have  no 
recollection  of  the  inaugural  exercises,  but  I  do  remember 
hearing  Huxley  at  the  Academy  of  Music,  principally,  I  think, 
on  account  of  the  storm  of  protest  that  followed.  This  protest 
was  directed  against  the  emphasis  which  the  new  university 
appeared  to  be  giving  to  scientific  research^  especially  in 
biology,  even  the  study  of  which  was  thought  at  that  time  to  be 
little  less  than  impious,  and  was  focused  on  the  fact  that 
Huxley,  the  great  champion  of  science,  had  been  asked  to 
speak  and  that  the  lecture  had  not  been  ushered  in  by  prayer* 
I  believe  that  Mr.  King  and  my  father,  both  devoted  religious 
workers,  were  responsible  for  this  last  circumstance.  They 
certainly  were  astounded  by  the  public  reaction  to  this  entirely 
consistent  Quaker  procedure. 

Following  the  advice  of  Huxley  and  others  the  chemical- 
biological  course  was  designed,  and  was  recommended  to  those 
students  who  intended  to  take  up  the  study  of  medicine;  in- 
deed, it  was  also  called  the  preliminary  medical  course.    It  was 


10  Sir  William  Osler,  Bart. 

from  the  first  the  design  of  the  "university  to  establish  the  full 
medical  course  as  soon  as  the  hospital  should  be  completed, 
and  much  thought  was  given  to  it.  Martin  and  Eemsen  were 
recognized  as  forming  the  nucleus  of  the  medical  faculty. 

At  the  opening  of  the  fourth  academic  year,  September, 
1879,  Professor  Acland,  then  Eegius  Professor  of  Medicine  at 
Oxford,  was  expected  to  give  a  lecture  embodying  his  advice 
as  to  the  proper  co-ordination  between  the  university  and 
hospital  in  the  organization  of  an  advanced  medical  school. 
Unfortunately,  on  account  of  illness,  he  was  unable  to  deliver 
the  address.  His  views,  however,  have  been  preserved  in  a 
letter  to  the  university  and  hospital  authorities.  How  sur- 
prised he  would  have  been  had  he  been  told  that  it  was  from 
this  unborn  medical  school  that  his  successor  at  Oxford  was  to 
be  chosen! 

In  the  early  days  the  university  was  a  small,  compact  body, 
made  up,  for  the  most  part,  of  a  young,  active  faculty,  sur- 
rounded by  a  group  of  advanced  workers,  called  fellows,  and 
other  post-graduate  students,  and  a  few  rather  over-powered 
undergraduates.  Every  encouragement  and  opportunity  was 
given  to  research  and  to  prompt  publication  of  work  accom- 
plished. There  was  the  closest  sympathy  among  all  the  depart- 
ments, and  everyone  knew  and  sympathized  with  the  work  of 
the  others.  It  was  naturally  around  Martin  that  the  idea  of 
the  medical  school  germinated,  and  a  more  inspiring  teacher 
it  would  be  hard  to  imagine.  Besides  the  regular  biological 
courses,  he  gave  lectures  to  medical  students  and  practitioners 
of  the  city,  and  graduates  in  medicine  entered  his  laboratory 
for  special  work. 

The  emphasis  which  the  university  had  put  upon  men  in 
contrast  to  buildings  had  permitted  it  to  function  at  once,  and 
to  strike  a  remarkable  pace  in  a  very  short  time.  With  the 
hospital  it  was  different;  buildings  were  absolutely  essential, 
and  even  though  Johns  Hopkins  before  his  death  had  in- 
structed his  hospital  trustees  to  begin  work,  time  was  neces- 
sarily consumed  in  the  formation  of  plans,  so  that  it  was  not 


The  Medical  School  and  Osler's  Advent         11 

until  June  of  1877  that  these  were  adopted  and  the  excavations 
were  begun. 

The  choice  by  the  hospital  board,  in  1876,  of  Dr.  John  S. 
Billings,  surgeon  of  the  United  States  Army,  and  librarian 
of  the  surgeon-generaFs  office,  as  their  medical  adviser  was 
most  fortunate,  both  as  to  the  construction  of  the  hospital 
buildings  and  as  to  the  future  of  the  medical  school.  Dr.  Bill- 
ings was  much  in  Baltimore,  and  his  encyclopaedic  knowledge 
of  things  medical  was  always  at  the  service  of  the  university 
as  well  as  the  hospital.  He  supplemented  Oilman,  and  made 
with  him  a  remarkable  team.  He  was  attached  to  the  uni- 
versity academic  staff  as  a  lecturer  on  the  history  of  medicine 
and  municipal  hygiene,  although  I  do  not  think  he  gave  many 
lectures  until  after  the  opening  of  the  hospital. 

Among  the  physicians  who  were  attracted  to  Martinis  labora- 
tory was  Wm.  T.  Councilman,  who  began  work  in  1878,  just 
after  having  received  his  medical  degree  from  the  University 
of  Maryland,  and  who,  after  his  return  from  Europe  in  1882, 
was  made  a  fellow  by  courtesy,  and  was  appointed  associate  in 
pathology  in  1884.  He  busied  himself  about  medical  problems, 
gave  some  courses  in  special  subjects,  and  lectured  at  the 
University  of  Maryland  on  pathology. 

In  1879,  Wm.  H.  Howell  came  from  the  Baltimore  City 
College  and  entered  the  chemical-biological  course  and  began 
a  career  which  was  to  mean  much  to  the  university  and  medical 
school.  He  soon  became  a  favorite  pupil  of  Martin's,  and  after 
receiving  his  bachelor's  degree,  he  was  made  in  quick  succes- 
sion a  fellow,  an  assistant,  and  then,  in  1885,  an  associate  in 
biology,  having  received  his  Ph.  D.  the  year  before.  He 
resigned  from  the  university  in  1889,  to  return  again  as  pro- 
fessor of  physiology  at  the  opening  of  the  medical  school. 

I,  in  my  capacity  as  experimental  animal,  was  entered  in 
the  university  the  same  year,  and  I  can  well  remember  Howell 
as  the  model  student  and  also  on  the  football  field  where  he 
made  up  for  his  light  weight  by  the  accuracy  and  neatness  of 
his  tackling. 


12  Sir  William  Osler,  Babt. 

I  look  back  upon  my  course  at  the  university  with  the 
greatest  pleasure.  To  have  been  under  such  men  as  Martin, 
Eemsen,  and  Hastings  in  physics,  to  have  read  Shakespeare 
with  Sydney  Lanier,  and  to  have  heard  the  lectures  from  the 
noted  men  who  were  constantly  coming  to  the  university,  could 
not  help  being  stimulating  to  a  youth  even  though  over- 
occupied  with  many  athletic  pursuits.  It  had  been  hoped  by 
those  of  us  who  took  the  preliminary  medical  course  that  at 
its  completion  the  university  would  have  started  its  medical 
school,  but  this  was  not  to  be.  The  buildings  of  the  hospital 
were  going  up  very  slowly,  and  as  there  seemed  no  immediate 
prospect  of  the  completion,  we  were  forced  to  go  elsewhere  for 
our  medical  instruction. 

While  at  the  University  of  Maryland,  I  attended  Dr.  Council- 
man's first  lectures  on  pathology,  and  also  took  a  course  with 
him  in  the  biological  laboratory  in  the  histology  of  the  nervous 
system.  We  had  excellent  professors  at  the  University  of 
Maryland,  but  it  was  the  old  lecture  system,  the  only  labora- 
tories being  the  dissecting  room  and  a  newly  established 
chemical  laboratory.  The  students  had  practically  no  chance 
of  getting  close  to  patients,  and  I  was  graduated  without  ever 
having  been  instructed  in  physical  diagnosis,  and  I  received 
the  prize  in  obstetrics  without  ever  having  seen  a  woman  in 
labor !  I  took  my  medical  degree  in  1885.  By  this  time  the 
university  was  on  the  point  of  establishing  its  medical  depart- 
ment. In  the  register  for  1883-1884  it  is  announced  that  "  The 
medical  department  of  the  university  is  soon  to  be  organized. 
Its  plan  is  receiving  the  constant  attention  of  the  trustees,  and 
it  will  be  made  known  before  the  completion  of  The  Johns 
Hopkins  Hospital.  The  nucleus  of  a  medical  faculty  has  been 
instituted  as  follows:  The  president  of  the  university;  J.  S. 
Billings,  M.  D.,  lecturer  on  hygiene;  W.  H.  Welch,  M.  D., 
professor  of  pathology;  Ira  Eemsen,  M.  D.,  professor  of  chem- 
istry; H.  Newell  Martin,  M.  D.,  professor  of  physiology.^' 

In  this  somewhat  casual  way,  the  university  announced  the 
epoch-making  facts  that  it  had  recognized  pathology  as  a  full 
university  subject,  and  had  appointed  Dr.  Welch  to  fill  the 


The  Medical  School  and  Osler's  Advent         13 

chair.  The  first  was  the  natural  development  of  the  university 
idea  in  medicine,  and  the  credit  of  the  second  has  been  claimed, 
in  a  friendly  rivalry  between  the  university  and  the  hospital, 
both  by  Oilman  and  by  Billings.  However  that  may  be,  no 
other  choice  now  seems  conceivable. 

Dr.  Welch's  appointment  was  the  first  one  that  had  to  do 
with  practical  medicine,  and  I  remember  my  father's  en- 
thusiasm over  it,  for  with  it  he  felt  that  the  university  had 
made  a  wonderful  beginning  in  medical  teaching.  What  a 
wonderful  beginning  it  was  he  was  to  learn  later ! 

Welch  gave  his  first  course  of  lectures  in  Hopkins  Hall  in 
February  and  March,  1886,  on  microorganisms  in  disease. 
The  hospital  trustees  allowed  the  university  to  furnish  the 
autopsy  house  as  a  pathological  laboratory,  and  so  the  first  of 
the  hospital  buildings  to  be  used  was  dedicated  to  the  common 
purpose  of  the  two  trusts.  Dr.  Councilman  had  been  appointed 
an  associate  in  pathology,  and  courses  of  instruction  were 
started  on  N'ovember  1,  1886.  Halsted  came  from  New  York 
to  work  in  the  laboratory  and  Mall  was  appointed  the  first 
fellow.  Other  students  gathered,  most  of  them  graduates  in 
medicine,  and  when  I  returned  from  Europe  at  the  end  of  the 
year  I  joined  the  group.  Those  early  days  have  often  been 
described,  and  it  was,  indeed,  a  rare  privilege  to  have  taken 
part  in  them.  As  the  hospital  was  not  yet  opened,  the  institu- 
tion had  to  depend  upon  other  sources  for  its  autopsy  material. 
This  was  obtained  for  the  most  part  from  the  City  Hospital 
at  Bay  View.  In  the  reorganization  of  this  charity.  The  Johns 
Hopkins  University  had  assumed  the  care  of  the  insane,  and 
my  father.  Dr.  Councilman  and  I  were  appointed  visiting 
physicians.    Dr.  Councilman  was  also  pathologist. 

At  this  time  everything  seemed  to  point  to  the  early  opening 
of  the  full  medical  school.  The  buildings  of  the  hospital  were 
practically  finished,  and  there  seemed  to  be  no  reason  why  they 
should  not  be  shortly  opened.  The  university  authorities  were 
completing  their  plans  and  Welch  was  on  the  spot.  It  was  just 
at  this  time  that  financial  calamity  overtook  the  university. 
The  Baltimore  and  Ohio  common  stock,  of  which  the  uni- 


14  Sir  William  Osler^  Bart. 

versity  had  nearly  15,000  shares,  dropped  its  dividend  from 
10  to  8  per  cent  in  1886,  to  4  per  cent  in  1887,  and  ceased 
paying  the  next  year;  the  university  was  struggling  for  life 
and  could  not  take  on  new  obligations,  so  that  the  plans  of  the 
medical  school  were  indefinitely  suspended.  The  hospital 
income  had  not  been  affected  as  it  was  derived  almost  entirely 
from  real  estate,  and  there  had  been  no  inroads  on  the  capital 
by  the  erection  of  the  hospital  buildings.  It  had,  indeed, 
increased,  and  the  hospital  had  now  become  the  rich  member 
of  these  organically  joined  twin  bequests. 

The  time  had  come  for  the  hospital  to  take  up  the  work,  but 
for  it  to  begin  to  function,  men  had  to  be  found  to  organize 
the  various  clinical  departments.  Above  all,  a  physician-in- 
ehief  had  to  be  appointed  and  everything  depended  upon  the 
choice.  The  question  was  anxiously  discussed  by  the  two 
boards  of  trustees  and  their  advisers,  and  the  little  band  of 
students  in  the  pathological  laboratory  discussed  the  question 
with  critical,  impotent  anxiety.  Now  that  adversity  had  fallen 
on  the  university,  what  hope  was  there  that  the  unbroken 
series  of  phenomenal  appointments  could  continue?  Where 
could  a  clinician  be  found  to  match  Gilman,  Billings,  Martin^; 
Eemsen,  and  Welch,  and  if  found,  would  such  a  man  come  now 
that  the  opening  of  the  medical  school  in  the  near  future  was 
less  than  probable  ?  We  doubted,  but  we  did  not  at  that  time 
know  Dr.  Osier  and  how  impossible  it  would  have  been  for 
him  to  have  refused  to  add  his  strength  to  the  endeavor  to 
bring  to  fruition  the  long-nourished  idea  of  a  real  university 
medical  school.  He  has  given  an  account  of  his  reaction  to 
the  proposal.  In  speaking  of  Billings'  visit  to  him  in  Phila- 
delphia, he  says:  "Without  sitting  down,  he  asked  me 
abruptly,  ^Will  you  take  charge  of  the  medical  department 
of  The  Johns  Hopkins  Hospital  ?  '  Without  a  moment's  hesi- 
tation I  answered,  ^  Yes.'  ^  See  Welch  about  the  details ;  we 
are  to  open  very  soon.  I  am  very  busy  to-day ;  good  morning,' 
and  he  was  off,  having  been  in  my  room  not  more  than  a  couple 
of  minutes." 


The  Medical  School  and  Osler's  Advent         15 

The  appointment  was  made  in  the  fall  of  1888,  and  he  was  to 
begin  his  service  at  the  opening  of  the  hospital,  which  was 
announced  for  May,  1889.  It  soon  became  evident  that 
although  it  was  easy  to  announce  the  opening  day,  it  was  quite 
another  thing  to  get  the  complicated  mechanism  of  the  hospital 
organized  and  ready  to  function.  In  this  emergency  the  hos- 
pital appealed  to  the  university  and  induced  Gilman  to  assume 
the  task.  The  work  was  colossal  and  the  time  was  short,  and  it 
speaks  volumes  for  the  estimation  in  which  Oilman's  organ- 
izing ability  was  held  that  no  one  doubted  the  result. 

The  formal  opening  occurred  on  May  7,  1889,  and  Osier, 
with  his  satellites,  took  his  place  as  our  guiding  star.  He 
brought  Lafleur  from  Montreal,  Scott  and  Toulmin  from 
Philadelphia,  and  those  of  us  who  were  able  to  do  so  joined  the 
ever-increasing  group. 

The  hospital  annexed  Welch  with  his  already  organized 
department  of  pathology.  Halsted  was  given  charge  of  the 
surgical  department  and  the  organization  of  the  dispensary, 
Kelly  was  brought  in  June  from  Philadelphia  to  take  charge 
of  gynaecology,  and  in  August  Dr.  Hurd,  as  superintendent 
took  over  from  President  Gilman  the  direction  of  the  hospital. 

The  opening  of  the  hospital  was  for  the  trustees,  the  faculty, 
and  above  all  for  us  expectant,  impatient  medical  novices,  the 
beginning  of  the  fulfillment  of  long-suppressed  desires.  For 
me  the  reality  far  surpassed  the  fantasy  of  my  dreams.  In  the 
association  that  was  to  follow,  which  for  my  part  was  as  close 
as  I  could  make  it.  Osier  as  a  physician,  teacher  and  friend, 
constantly  raised  my  preconceived  ideal.  Memories  of  this 
time  overwhelm  me. 

The  dispensary  was  opened  first  and  patients  were  admitted 
to  the  wards  from  it,  and  Osier,  surrounded  by  a  few  of  us, 
himself  wrote  the  first  dispensary  history.  Until  the  wards 
were  full  he  was  constantly  in  the  dispensary,  organizing  the 
various  sub  departments  of  medicine,  for  it  was  an  unique 
feature  of  the  system  that  the  services  were  continuous,  and 
that  the  various  special  departments  were  grouped  under 
either  medicine  or  surgery.    As  it  was  in  the  early  days  of  the 


16  Sir  William  Osler,  Baet. 

■amversit}^  so  it  was  with  the  hospital  at  the  beginning. 
Workers  formed  a  closely  united  body.  All  that  happened  was 
of  interest  to  each  of  ns.  On  the  medical  side  Osier  radiated 
by  his  example  and  personality  constant  stimuli  to  careful 
clinical  work  and  investigation  along  all  sorts  of  lines.  He 
23ointed  out  problems,  encouraged  everyone  in  what  he  desired 
to  do,  and  was  more  than  liberal  in  his  commendation  of  work 
done.  His  absolute  generosity  threw  open  his  whole  clinical 
material  to  the  use  of  anyone  who  had  a  problem.  He  urged 
and  assisted  in  the  publication  of  the  results,  and  saw  to  it  that 
the  young  men  got  the  whole  credit  of  the  work  when  often  it 
should  have  gone  to  himself.  Is  it  to  be  wondered  at  that  such 
a  chief  has  such  devoted  followers  ? 

The  Medical  Society,  the  Journal  Club,  the  Historical  Club, 
and  other  associations,  were  organized  in  quick  succession. 
Post-graduate  courses  were  given,  but  the  medical  school  of 
the  university  seemed  as  far  from  beginning  as  ever.  The 
university  trustees  were  not  unmindful  of  the  question,  and 
some  of  them  in  spite  of  the  depleted  income,  were  constantly 
urging  the  establishment  of  the  school.  I  have  found  among 
my  father's  papers  the  notes  of  an  earnest  appeal  on  the  subject 
which  he  appears  to  have  made  to  the  Board  of  Trustees  in 
May,  1890.  Certain  women,  several  of  whom  were  daughters 
of  trustees,  who  had  from  the  first  unsuccessfully  sought  admis- 
sion for  themselves  and  other  women  to  the  university,  and 
who  had  been  told  that  it  was  planned  to  admit  women  to  the 
medical  school  when  it  should  be  established,  collected  money 
and  offered  $100,000  to  the  trustees  on  condition  that  it  should 
be  used  to  help  the  establishment  of  a  medical  school  to  which 
women  should  be  admitted  on  the  same  terms  as  men.  On 
October  29,  1890,  the  trustees  made  a  minute  accepting  the 
gift,  with  the  proviso,  however,  that  the  university  should  not 
establish  its  medical  school  until  an  endowment  of  $500,000 
had  been  secured,  and  that  women  who  desired  to  enter  should 
receive  their  preliminary  education  somewhere  else.  Miss 
Mary  E.  Garrett,  who  had  contributed  most  of  the  original 
Women's  Medical  Fund,  completed  the  endowment  on  Decern- 


The  Medical  School  and  Osler's  Advent         17 

ber  22,  1892,  by  a  gift  of  $306,977.  Leading  up  to  this  gift 
there  was  a  protracted  three-sided  discussion  between  Miss 
Garrett  and  her  friends,  the  Medical  Faculty  and  the  Board  of 
Trustees.  The  outlook  for  an  agreement  was  often  gloomy, 
and  only  one  who  was  in  a  position  to  know,  as  I  was,  some- 
thing of  the  ideas  of  all  three  parties  to  the  negotiation,  can 
realize  on  how  many  occasions  the  scheme  came  close  to  being 
abandoned.  In  this  discussion,  together  with  Welch  and 
Martin,  Osier  was  deeply  concerned.  He  had  become  very 
restive  under  the  delay  of  the  opening  of  the  medical  school, 
complained  to  me  on  one  occasion  of  what  he  called  the  dry 
bones  of  post-graduate  teaching,  and  even  intimated  that 
unless  something  were  done  he  might  be  forced  to  go  where 
there  were  some  real  medical  students. 

The  decision  as  insisted  upon  by  Miss  Garrett,  to  fix  per- 
manently by  the  terms  of  the  gift  the  conditions  for  admission 
to  the  medical  school  at  an  unprecedented  standard,  required 
no  little  courage,  and  although  the  results  have  abundantly 
justified  it,  it  was  then  thought  that  it  would  greatly  limit 
the  number  of  students  who  would  apply  for  admission.  The 
first  class  of  17,  including  three  women,  entered  in  the  fall 
of  1893.  When,  in  the  third  year,  they  began  to  work  in  the 
hospital,  first  in  the  dispensary  and  then  in  the  wards,  Osler^s 
genius  as  a  medical  teacher  became  more  and  more  evident. 
He  saw  to  it  that  the  students  came  into  the  closest  contact  with 
the  patients  in  the  dispensary,  and  he  organized  the  hospital 
wards  so  that  the  fourth-year  students  took  an  essential  part 
in  the  management  of  the  cases.  Although  this  last  had  been 
the  intention  since  the  inception  of  the  hospital,  and  the  main 
building  had  been  designed  to  house  20  senior  students,  its 
practical  application  met  with  opposition  and  presented  diffi- 
culties, and  it  was  Osier's  insistence  that  threw  open  the  wards 
to  the  students,  a  fact,  the  thought  of  which,  I  think,  always 
gives  him  pleasure. 

He  did,  indeed,  put  the  students  into  the  wards,  but  he  did 
not  leave  them  there.  He  stayed  with  them,  and  if  ever 
medical  students  got  clinical  instruction  on  a  university  basis, 
2 


18  Sir  William  Osler,  Baet. 

they  did.  It  is  not  given  to  me  to  speak  of  Osier  as  a  teacher, 
for  my  chapter  ends  with  the  beginning  of  the  medical  school. 
For  me,  and  for  others  similarly  situated,  who  had  been  reared 
in  the  expectation  of  the  new  order  in  medical  education,  the 
coming  of  Osier  ushered  in  the  complete  realization  of  long- 
deferred  hopes.  He  set  for  ns  a  difficnlt  goal,  and  helped  and 
cheered  us  on  the  way  by  his  wise  precepts,  his  kindly,  friendly 
commendation,  his  vigorous  leadership,  and  more  than  all,  by 
simply  being  himself. 

It  is  no  fault  of  his  that  the  finished  product  is  no  better, 
but  what  good  there  is  in  me  as  a  teacher  and  a  physician  I  owe 
to  him,  and  on  this,  his  birthday,  I  lay  it  at  his  feet  in  grateful 
acknowledgment. 


1902. 


OSLER  AS  CHIEF  OF  A  MEDICAL  CLINIC 

By  Lewellys  F.  Bakkek 

Internal  medicine,  like  other  branches  of  science,  though 
making  at  all  times  some  progress,  is  subject  in  its  advance  to 
fits  and  starts,  the  result  of  unusual  concatenations  of  events. 
The  opening  of  the  medical  clinic  at  The  Johns  Hopkins 
Hospital  in  1889  was  an  opportunity  for  helping  on  the  science 
and  art  of  medicine  that  might  amount  to  either  much  or  little, 
depending  upon  its  seizure.  The  time  corresponded  to  the  flood- 
tide  of  natural  science.  Biology,  physics  and  chemistry  had 
participated  in  the  great  rise.  Medicine,  always  quick  to  apply 
to  its  own  service  the  results  of  investigations  in  the  funda- 
mental sciences,  had  responded  by  establishing  a  whole  series 
of  special  medical  sciences  (anatomy,  histology,  embryology, 
physiology,  physiological  chemistry,  pharmacology,  pathologi- 
cal anatomy  and  physiology,  bacteriology),  to  be  studied  and 
taught  by  men  who  gave  up  their  lives  exclusively  to  their 
promotion ;  these  sciences  were  to  serve  as  a  foundation  upon 
which  a  great  superstructure  of  cKnical  science  and  art  might 
be  built.  The  place  to  be  filled,  the  professorship  of  medicine 
in  The  Johns  Hopkins  University,  which  carried  with  it  the 
appointment  as  physician-in-chief  to  The  Johns  Hopkins  Hos- 
pital, was  in  several  ways  unique,  at  least  as  far  as  medicine 
in  America  was  concerned.  For,  in  the  first  place,  according 
to  the  will  of  Johns  Hopkins,  the  well-endowed  hospital  was 
designed  to  be  an  integral  part  of  the  medical  school  of  an 
endowed  university,  and  funds  were  provided  for  salaries  for 
the  leaders  of  the  clinics  as  well  as  for  the  chiefs  of  other  uni- 
versity departments,  one  of  the  circumstances  that,  combined 
with  others,  led  to  the  abandonment  of  the  hitherto-prevailing 
"  proprietary  medical  schools  '^  and  to  their  replacement  by 
medical  schools  organized  as  parts  of  great  universities.  In 
the  second  place,  The  Johns  Hopkins  University,  through  the 

19 


20  Sir  William  Osler,  Bart. 

action  of  its  trustees,  and  of  its  first  president,  Daniel  C. 
Gilman,  had  been  organized,  in  all  its  departments,  in  the 
interests  of  original  research  as  well  as  of  competent  instruc- 
tion ;  with  distinguished  investigators  in  the  arts  department 
and  with  men  like  Martin  and  Brooks  in  biology  and  physi- 
ology, Rowland  in  physics,  Remsen  in  chemistry,  and  Welch 
in  pathology,  it  was  clear  that  capacity  for  personal  research 
and  the  power  to  stimulate  others  to  engage  in  fruitful  re- 
searches were  regarded,  along  with  ability  to  teach  and  to< 
organize,  as  essential  requirements  of  the  occupants  of  chairs 
in  the  university.  And,  in  the  third  place,  the  trustees  of  the 
hospital,  in  consultation  with  the  president  of  the  university, 
the  professor  of  pathology,  and  Dtr.  John  S.  Billings  of  the 
surgeon-general's  library,  had  planned  and  built  (out  of 
income  from  the  endowment),  a  hospital  that,  at  the  time  of 
its  completion,  offered  better  facilities  for  the  organization 
and  conduct  of  clinical  work  than  had  heretofore  been  avail- 
able in  the  IJnited  States.  The  ideals  cherished  in  the  uni- 
versity, the  material  equipment  at  the  hospital,  the  oppor- 
tunities and  possible  rewards  open  to  the  clinical  leaders  who 
might  be  appointed,  combined  to  provide  unparalleled  places 
for  occupancy.  If,  then,  for  these  positions  clinical  men  could 
be  found,  who,  by  native  ability  and  experience,  would  measure 
up  to  the  extraordinary  time  and  the  unusual  opportunities, 
success  in  the  highest  sense  for  the  new  institution  would  seem 
to  be  ensured.  The  chair  of  medicine  is,  by  common  consent, 
the  most  important  clinical  chair  in  a  university  medical 
school.  For  this  professorship  the  university  faculty  recom- 
mended, and  the  trustees  confirmed,  the  appointment  of 
Dr.  William  Osier,  then  engaged  in  teaching  medicine  in  the 
University  of  Pennsylvania  and  in  consultation  practice  in 
Philadelphia.  A  member  of  a  distinguished  Canadian  family, 
trained  in  medicine  first  in  the  University  of  Toronto  and  in 
McGill  University  in  Montreal,  and,  later,  as  a  graduate  stu- 
dent, in  the  clinics  and  laboratories  of  England,  France  and 
Germany,  interested  and  occupied  in  research  and  teaching  in 
histology,  physiology,  pathology  and  parasitology  as  well  as  in 


As  Chief  of  a  Medical  Clinic  21 

internal  medicine,  and  possessing  personal  qualities  that  even 
in  youth  marked  him  as  a  potential  leader  of  men,  the  ap- 
pointee entered  upon  his  work  with  an  enthusiasm  that  was 
stimulating,  began  to  organize  his  department,  selecting  a 
group  of  young  men  as  assistants,  and  soon  set  an  example  in 
practice,  teaching  and  investigation  that  was  contagious.  The 
office  and  the  man  were  suited  to  one  another.  The  time,  the 
place,  and  the  person  formed  a  happy  conjuncture  that  was  to 
mean  much  for  internal  medicine  in  America  and  in  the  world. 
Of  the  set  of  brief  contributions  here  published  concerning 
Professor  Osier's  work  in  Baltimore,  those  dealing  with  his 
practice,  his  teaching,  and  his  original  inquiries  are  written 
by  others;  the  part  assigned  to  me  is  the  preparation  of  a 
memorandum  outlining  the  principles  to  which  he,  as  the 
organizer  of  a  medical  clinic,  persistently  adhered,  and  the 
methods  he  employed  in  their  practical  application.  He  had 
very  definite  ideas  of  what  a  medical  clinic  should  be  and  he 
felt  keenly  the  responsibility  of  seeing  to  it  that  the  functions 
of  the  clinic  were  faithfully  performed.  For  him,  the  welfare 
of  the  patients  who  presented  themselves  in  the  clinic  for 
diagnosis  and  treatment  came  first ;  next,  came  into  considera- 
tion how  undergraduate  and  graduate  students  could  best  be 
taught;  and,  finally,  came  solicitude  that  every  opportunity 
for  contributing  to  the  advance  of  our  knowledge  of  internal 
medicine  should  be  eagerly  seized.  He  took  care  to  promote  in 
every  way  possible  the  material,  the  scientific,  and  the  moral 
interests  of  all  who  were  associated  with  him  in  his  work;  his 
personal  advantage  concerned  him  but  little,  though  to  anyone 
who  aimed  at  such  objects  and  achieved  such  purposes  as  he 
did,  a  modicum  of  profit  and  a  maximum  of  honor  and 
prestige  were  bound  to  accrue.  The  principles  he  fixed  upon 
and  the  methods  he  used  to  illustrate  them  were  manifoldly 
derived.  In  part  they  grew  out  of  personal  practical  experi- 
ence, in  part  they  had  their  origin  in  other  clinics  in  this 
country  and  in  Europe.  Men  who  were  familiar  with  clinical 
work  and  clinicians  in  the  larger  centers  of  America,  those 
who  had  "  walked  the  hospitals  "  of  London  and  Edinburgh, 


22  SiE  William  Oslek,  Baet. 

those  who  knew  the  laboratories  and  the  clinical  institutes  of 
Austria,  Germany  and  Holland,  and  those  who  had  visited  the 
clinics  conducted  by  the  best  internists  in  France,  had  no 
difficulty  in  recognizing  the  sources  of  certain  of  the  features 
of  the  organization  of  the  medical  service  in  Baltimore.  Pro- 
fessor Osler^s  clinic  synthesized  diverse  elements  into  a  har- 
monious whole;  it  represented  a  new  form,  good  in  itself  for 
its  time,  and  yet  plastic  enough  to  admit  of  remoulding  at 
later  need.  The  limits  of  this  article  will  permit  of  only  brief 
comment  upon  the  plan  of  organization  and  upon  the  way  it 
was  managed. 

Where  activities  are  complex,  be  they  those  of  a  factory,  of  a 
business  office,  of  a  scientific  laboratory,  or  of  a  medical  or 
surgical  clinic,  organization  and  management  are  two  execu- 
tive functions  that  must  be  properly  exercised,  if  the  work  is  to 
be  successful.  Organization  involves:  (1)  An  investigation 
of  the  conditions  that  exist  and  of  the  requirements  of  the 
whole  situation;  (2)  the  planning  of  a  scheme  that  will  meet 
the  requirements,  that  will  effectively  and  systematically  cor- 
relate the  activities  of  the  working  force,  the  materials,  the 
equipment  and  the  working  space,  so  that  the  functions  of  the 
institution  shall  be  competently,  speedily  and  economically 
performed;  and  (3)  the  actual  installation  of  the  system  as 
planned.  Management,  or  the  art  of  conducting  an  establish- 
ment after  its  organization  has  been  devised  and  initiated, 
involves :  ( 1 )  The  attainment  of  the  results  that  are  aimed  at ; 
(2)  the  overcoming  of  obstacles  that  are  incident  to  the  con- 
ditions under  which  the  work  has  to  be  done;  and  (3)  the 
application  of  knowledge  and  skill  in  the  training  of  the  staff, 
in  the  setting  up  and  in  the  maintaining  of  standards,  in  the 
providing  of  suitable  incentives,  and  in  the  establishing  of 
right  relationships  between  the  leader  and  the  led.  The  head 
of  an  institution,  or  of  a  department,  who  creates  an  organiza- 
tion that  is  adequate,  and  who  manages  it  with  skill,  demon- 
strates his  executive  capacity. 

On  Professor  Osier's  appointment  as  physician-in-chief  to 
The  Johns  Hopkins  Hospital  in  1888,  he  found  certain  con- 


As  Chief  of  a  Medical  Clinic  23 

ditions  already  existing  that  were  to  some  extent  determining, 
at  least  as  far  as  the  general  organization  of  the  institution  was 
concerned.  The  buildings  already  completed  included  one  for 
general  administration,  with  a  building  on  each  side  of  it  for 
private  patients,  a  long  row  of  public  ward  buildings  behind,  a 
building  for  a  general  out-patient  department,  a  nurses'  home, 
a  pathological  laboratory,  a  general  kitchen  and  a  laundry.  In 
other  words,  a  "  general  hospital,''  in  which  medical  and  surgi- 
cal patients  (free  and  pay)  were  to  be  received,  distributed  and 
treated,  and  in  which,  later  on,  medical  students  were  to  be 
taught,  had  been  constructed  on  the  pavilion  system.  There 
was  no  spatial  concentration  of  the  work  of  the  single  depart- 
ments in  separate  institutes  such  as  had  already  developed  in 
some  of  the  European  centers,  or,  as  was  later  adopted  in  the 
institutes  built  for  psychiatry  and  pediatrics  on  the  grounds 
of  The  Johns  Hopkins  Hospital ;  on  the  contrary,  to  pass  from 
some  of  his  private  patients  in  Ward  B  at  the  southwest  corner 
of  the  grounds  to  some  of  his  public-ward  patients  at  the 
northeast  corner,  the  internist  and  his  staff  were  compelled  to 
walk  through  corridors  that  extended  along  two  sides  of  a 
square  containing  14  acres  !  As  in  most  general  hospitals,  the 
functions  of  general  superintendency,  financing,  accounting, 
nursing,  purveying  and  housekeeping  had  been  centralized, 
and  with  them  the  heads  of  the  clinical  departments  had  but 
little  to  do.  But,  thus  relieved  of  much  administrative  detail, 
the  head  of  the  medical  department,  who  was  appointed  per- 
manently and  had  a  continuous  service,  was  to  have  a  large 
degree  of  autonomy  in  the  diagnosis  and  treatment  of  patients, 
in  the  selection  of  his  staff,  in  the  character  and  amount  of  his 
teaching,  and  in  the  conduct  of  research.  His  staff  was  to  con- 
sist (1)  of  younger  men  who  lived  in  the  hospital  and  gave 
their  whole  time  to  the  department,  and  (2)  of  senior  asso- 
ciates who  lived  outside,  giving  part  of  their  time  to  the 
hospital  and  part  to  private  practice.  The  chief  of  the  medical 
service  was  to  be  paid  a  salary  in  order  that  he  might  make  the 
work  of  the  hospital  and  of  the  medical  school  his  main  occu- 
pation and  interest,  though  he  was  permitted  to  supplement 


24  Sir  William  Osler,  Baet. 

his  income  and  clinical  experience  by  private  consultations. 
The  activities  of  the  different  clinical  departments  were  to  be 
correlated  partly  by  the  general  superintendent  of  the  hospital, 
and  partly  by  a  medical  advisory  board  that  made  recommen- 
dations to  the  trustees  of  the  hospital.  When  Professor  Osier 
arrived,  the  buildings,  and  the  general  plan  of  organization 
already  completed,  had  to  be  accepted  as  they  were ;  the  plans 
of  his  department  had  to  be  drawn  so  as  to  fit  into  them. 

It  was  fortunate  that  The  Johns  Hopkins  Medical  School 
was  not  opened  until  1893  and  that  clinical  instruction  of 
undergraduates  did  not  begin  until  1895,  for  six  years  were 
thus  available  for  perfecting  the  organization  of  the  wards,  the 
out-patient  department,  the  laboratories,  the  staff,  the  records, 
the  library,  the  hospital,  the  medical  society,  and  the  care  of 
patients  in  the  hospital  before  the  function  of  teaching  under- 
graduates was  added.  Courses  for  post-graduate  students 
were,  it  is  true,  offered  during  this  period,  but  the  number  of 
candidates  was  small  and  the  work  was  not  burdensome.  With 
few  patients  at  first,  a  small  staff,  and  a  limited  amount  of 
post-graduate  instruction,  leisure  was  given  for  making  plans 
(and  for  modifying  them  after  small-scale  trials  in  executing 
them),  for  instituting  standards,  for  writing  a  text-book  that 
concisely  embodied  the  principles  and  practice  of  medicine  and 
that  was  destined  to  have  an  unprecedented  distribution  among 
physicians  and  students,  and,  in  general,  for  establishing  tra- 
ditions of  the  better  sort  in  the  clinic.  With  the  organization 
thus  far  planned  and  installed  before  the  students  of  the 
medical  school  entered  upon  their  clinical  work,  it  was  a 
relatively  easy  matter  to  expand  it  and  to  adapt  it  to  the  func- 
tions of  undergraduate  instruction  when  the  time  for  this 
arrived. 

When  the  definitive  history  of  Professor  Osier's  work  in 
Baltimore  is  written,  many  details  of  his  analysis  of  the  func- 
tions of  the  clinic,  of  his  applications  of  the  principle  of 
division  of  labor  in  the  cHnic,  of  his  methods  of  selecting  men, 
of  assigning  them  to  appropriate  tasks,  and  of  motivating  them 
to  high  endeavor,  and  of  the  personal  qualities  through  which 


As  Chief  of  a  Medical  Clinic  25 

he  exerted  that  profound  and  lasting  influence  upon  patients, 
students,  assistants,  and  colleagues  for  which  he  is  so  widely 
known,  must  be  recorded.  The  scope  of  the  present  memo- 
randum will  permit  mention  of  only  a  few  of  the  more  out- 
standing features  of  his  organization  and  management,  of 
those  parts  that  made  his  clinic  so  successful  a  department  of 
a  university  teaching  hospital  as  it  is  known  to  have  been. 

One  important  element  of  success  in  the  new  clinic  was  the 
arrangement  for  a  graded  staff,  particularly  for  a  graded, 
whole-time,  resident  staff,  among  the  members  of  which  the 
responsibilities  of  the  work  were  divided,  not  according  to  a 
so-called  "  military  type,'^  but  rather  in  the  manner  of  the 
so-called  "  composite  functional  type  "  of  organization.  The 
professor  of  medicine  (physician-in-chief  to  the  hospital), 
though  giving  most  of  his  time  to  the  work  of  the  clinic,  lived 
outside  the  hospital,  as  did  the  associate  professors  who 
"  visited  ^^  the  wards,  the  out-patient  department,  and  the 
laboratories.  The  resident  physician,  the  assistant  resident 
physicians,  and  the  medical  internes  lived  in  the  hospital  and 
were  in  close  contact  with  the  work  always  by  day  and  as  far 
as  was  necessary  also  by  night.  The  resident  staff  of  the  clinic 
consisted  of  two  parts :  (1)  A  lower  resident  staff  constituted 
by  the  medical  internes  appointed  for  a  single  year,  usually  on 
graduation  with  high  standing  from  the  medical  school;  and 
(2)  an  upper  resident  staff  made  up  of  the  resident  physician 
and  several  assistant  resident  physicians,  usually  men  of  excep- 
tional promise,  men  who  had  already  served  as  hospital  internes 
and  who  were  willing  to  enter  upon  a  more  or  less  prolonged 
resident  service,  often  of  several  years'  duration,  in  order  to 
secure  the  best  possible  training  for  the  "  higher  walks  "  of 
internal  medicine.  This  upper  staff  was  chosen  partly  from 
the  lower  staff,  partly,  in  order  to  prevent  "  inbreeding/' 
from  members  of  the  resident  staffs  of  hospitals  in  distant 
medical  centers.  The  position  of  chief  resident  physician, 
which  carried  with  it  large  responsibilities  and  opportunities, 
was  a  prize  to  be  won  only  by  men  of  exceptional  ability,  ex- 
tensive experience,  and  favorable  promise.    Thus,  those  receiv- 


26  Sm  William  Oslee,  Baet. 

ing  it  in  Professor  Osiers  time,  included  Henry  A.  Laflenr 
(1889-1891),  William  S.  Thayer  (1891-1898),  Thomas  B. 
Fntcher  (1898-1901),  Thomas  McCrae  (1901-1904),  and 
Eufus  I.  Cole  (1904-1906).  The  careers  of  these  men  during 
their  terms  of  service  and  since  illustrate  on  the  one  hand  the 
wisdom  of  him  who  selected  them,  and  on  the  other  the  growth- 
promoting  influence  of  the  duties  and  authority  attached  to 
the  office.  The  assistant  residents,  even  those  who  did  not 
later  become  chief  resident  physicians,  often  continued  in  office 
for  several  years.  Such  an  upper  resident  staff,  supported  by 
internes  and  by  senior  students,  besides  forming  a  whole-time 
group  of  enthusiastic  young  internists  for  development  under 
ideal  conditions,  afforded  an  excellent  working  force  for  carry- 
ing on  the  routine  of  the  wards,  laboratories,  and  out-patient 
department:  this  left  the  physician-in-chief  and  his  visiting 
associates  largely  free  for  planning,  standardizing,  supervising 
and  controlling  the  practice  in  the  clinic,  for  teaching,  and  for 
promoting  original  inquiries.  The  historian  bent  on  analyzing 
the  conditions  of  achievement  in  Professor  Osler^s  clinic  will 
do  well  to  consider  carefully  the  significance  of  this  upper 
resident  staff. 

A  second  characteristic  feature  of  the  medical  clinic  organ- 
ized by  Professor  Osier  was  the  introduction  of  more  extensive 
and  more  systematic  courses  of  instruction  in  the  practical- 
technical  methods  of  gathering  data  regarding  disturbances  of 
structure  and  function  in  the  sick  than  had  before  been  cus- 
tomary. The  importance  of  careful  history-making  and  of 
accurate  physical  diagnosis  had  been,  it  is  true,  generally 
recognized ;  but  the  machinery  of  instruction  in  these  forms  of 
fact-accumulation  had  been  inadequate  in  the  majority  of 
medical  clinics,  and  one  of  the  first  tasks  of  the  new  clinic  con- 
sisted in  planning  and  installing  a  better  organization  for  this 
purpose,  and  in  seeing  to  it  that  the  example  set  by  all  who 
participated  in  the  practical  work  of  diagnosis  in  the  clinic 
was  consistent  with  the  methodological  teaching.  The  most 
distinctive  advance  made  in  instruction  in  technique  was, 
however,  the  establishment  of  a  systematic  course  in  the  appli- 


As  Chief  of  a  Medical  Clinic  27 

cation  of  the  laboratory  methods  of  chemistryj  physics,  and 
biology  to  the  study  of  patients.  Students  in  their  third  year 
of  the  medical  school  were  not  only  taught  the  principles  of 
these  methods,  but  for  two  or  three  afternoons  throughout  the 
year  were  thoroughly  drilled  in  the  practical  technique  of  these 
methods,  so  that,  when  the  course  had  been  completed,  each 
student  had  attained  to  real  skill  in  the  use  of  all  the  more 
important  ways  of  examining  clinically  the  blood,  the  stomach 
Juice,  the  feces,  the  urine,  and  the  cerebrospinal  fluid.  No 
medical  school  has  yet  devised  a  perfect  system  of  training, 
and  the  graduates  of  The  Johns  Hopkins  Medical  School, 
like  those  of  other  schools,  doubtless  exhibit  certain  special 
defects,  but  by  common  consent,  they  are  well-trained  in  the 
methods  of  gathering  clinical  facts  and  especially  in  the 
technical  procedures  of  the  clinical  laboratory.  By  many  it  is 
believed  that,  of  the  several  contributions  made  by  Professor 
Osier  to  the  organization  of  the  clinic,  the  development  of  the 
clinical  laboratory  and  of  the  thorough  education  of  students 
by  competent  instructors  in  clinical  laboratory  work  before 
entering  upon  their  duties  in  the  medical  wards  is  pre- 
ponderant. 

A  third  distinctive  mark  of  the  organization  in  Dr.  Osier's 
clinic  was  the  arrangement  by  which  each  student  of  the 
medical  school  became  for  a  considerable  period  a  member  of 
the  group  that  actually  did  the  work  of  the  diagnosis  of  disease 
and  of  the  treatment  of  patients  in  the  hospital.  Thus  each 
student  in  his  third  year,  after  having  had  instruction  in 
history-making  and  in  the  elements  of  physical  diagnosis, 
assisted,  under  the  supervision  and  control  of  instructors,  in 
recording  histories  and  in  making  physical  examinations  in 
the  out-patient  department.  More  important  still,  through  the 
fourth  year  of  the  course,  each  third  of  the  class  acted  suc- 
cessively for  three  months  as  '^^ clinical  clerks''  in  the  sta- 
tionary medical  clinic,  giving  their  whole  time  to  the  work  of 
the  medical  wards.  Thus  the  medical  staff  was  reinforced 
during  the  entire  school  year  by  30  student  assistants,  who, 
under  the  eye  of  the  resident  staff,  took  the  histories  of  all  new 


28  Sir  William  Osler,  Bart. 

patientS;,  assisted  the  internes  in  the  making  of  the  first 
physical  examinations,  made  all  the  clinical  laboratory  tests 
on  these  patients,  and  accompanied  their  chief  on  morning 
rounds.  At  these  rounds,  the  clinical  clerk  gave  orally  an 
epitome  of  the  findings  in  the  patient,  watched  the  processes  of 
control  examinations  used  by  the  professor,  and  participated 
at  the  bedside  in  discussions  of  the  pathological-physiological, 
pathological-anatomical,  and  etiological  bearings  of  the  case. 
He  looked  up  recent  articles  on  the  subject  and  reported  them 
at  later  ward  rounds,  followed  the  patient  to  the  operating 
room  if  surgical  procedure  were  indicated,  watched  the  effects 
of  the  treatment  employed  in  the  case  of  each  patient  directly 
assigned  to  him,  and  kept  in  touch  with  him  during  conva- 
lescence at  his  home  after  discharge  from  the  hospital,  or  in 
the  event  of  a  fatal  issue  attended  the  autopsy  and  the  patho- 
logical-clinical conference  that  followed  it.  The  fact  that 
through  all  this  he  was  regarded  as  an  integral  part  of  the 
working  group  of  the  clinic,  the  knowledge  that  the  anamneses 
he  registered  and  the  results  of  laboratory  tests  he  made  be- 
came a  part  of  the  permanent  records  of  the  hospital,  the  feel- 
ing of  responsibility  he  had  when  he  realized  that  the  diagnosis 
made  and  the  treatment  instituted  were  based  in  part  upon 
data  accumulated  by  liim,  the  personal  relationships  estab- 
lished between  student  and  professor  at  the  hospital  and  on 
delightful  Saturday  nights  at  the  professor's  home  at  1  West 
Franklin  Street-— all  this  combined  to  make  the  time  of  the 
clinical  clerkship  in  Professor  Osler^'s  clinic  a  period  of  rich 
experience  and  of  intense  stimulation,  never  to  be  forgotten 
by  any  pupil  who  passed  through  it.  Even  in  the  more  formal 
teaching  of  the  clinic,  it  was  Professor  Osier's  custom  to  permit 
the  clinical  clerk  to  have  a  share.  Thus,  at  the  main  teaching 
event  of  the  week,  the  crowded  Saturday  clinic  in  the  amphi- 
theater, where  all  the  students  of  the  third  and  fourth  year, 
the  whole  resident  staff,  many  of  the  visiting  physicians  of  the 
hospital,  physicians  of  the  town  and  medical  men  from  a  dis- 
tance were  assembled,  the  clinical  clerk  gave  a  part  of  the 
clinic;  he  was  always  asked  to  tell  the  audience  briefly  (and 


As  Chief  of  a  Medical  Clinic  29 

from  memor}^  unaided  by  notes)  the  main  points  of  the 
anamnesis  of  the  patient  and  was  called  upon  from  time  to 
time  throughout  the  hour  to  report  on  laboratory  tests  and 
X-ray  findings,  or  to  give  his  opinion  of  the  significance  of 
some  datum.  The  pupil-teacher  thus  grew  accustomed  to  fac- 
ing a  large  audience  and  to  thinking  and  speaking  on  his  feet, 
an  admirable  preparation  for  some  of  the  contingencies  of  later 
professional  life.  The  student-assistantships  in  the  out-patient 
department  (in  the  third  year)  and  the  clinical-clerkships  and 
all  that  they  implied  (in  the  fourth  year)  were,  then,  vital 
parts  of  the  organization  of  The  Johns  Hopkins  Medical 
Clinic. 

Though  the  organization  of  the  clinic  in  Baltimore  pre- 
sented, as  we  have  seen,  an  interesting  combination  of  novel 
features,  no  organization,  no  matter  how  well  planned  and 
installed,  can  function  effectively  without  the  skilful  applica- 
tion of  the  art  of  management,  and  in  the  art  of  management 
the  director  of  this  clinic  was  to  prove  that  he  was  a  master. 
Thoroughly  familiar  himself  with  the  principles,  methods  and 
problems  of  internal  medicine,  enthusiastic  about,  and  for  his 
time  well  trained  in,  the  preclinical  sciences  that  are  funda- 
mental, he  possessed  that  personal  experience  in  his  subject 
and  that  superior  ability  that  are  always  prerequisites  to 
competence  as  a  manager  and  to  the  command  of  the  respect  of 
those  that  are  to  be  managed.  He  understood  human  nature 
and  loved  it,  despite  its  faults  and  its  frailties;  no  chief  ever 
secured  in  greater  measure  the  good-will  and  loyalty  of  his 
staff.  Though  he  could  be  firm  on  occasion,  he  rarely  found 
need  to  act  as  a  strict  disciplinarian.  He  was  always  cognizant 
of  the  good  qualities  of  those  about  him,  and  though  not  blind 
to  their  defects  he  had  learned  that  great  lesson  of  successful 
management  that,  for  most  subordinates,  a  word  of  apprecia- 
tion is  of  far  greater  value  as  a  stimulus  to  good  work  than  a 
volume  of  carping  criticism.  He  possessed  to  an  extraordinary 
degree  the  capacity  of  making  you  feel  that  he  was  interested 
in  you  and  in  your  personal  welfare ;  to  come  into  contact  with 
him  meant,  for  most,  the  birth  of  a  genuine  affection  for  him. 


30  Sir  William  Osler,  Baet. 

He  had  an  orderly  mind  and  manner;  he  landed  punctuality 
in  a  doctor  and  was  always  punctual  himself.  He  seemed, 
never  to  be  in  a  hurry  and  yet  he  wasted  no  time.  Many  a  man 
recalling  an  interview  that  seemed  leisurely  when  it  occurred 
has  been  surprised,  on  analyzing  it  afterward,  to  find  how  brief 
it  had  been.  He  belonged  to  the  first  of  the  two  groups — the 
"  larks  ^'  and  the  "owls" — into  which  men  have  been  play- 
fully divided.  He  retired  early  and  was  an  early  riser.  At 
one  time  he  lived  for  some  months  in  the  hospital  and  it  is 
asserted  that  men  learned  to  set  their  watches  at  10  p.  m.  by 
the  sound  of  his  boots  as  they  dropped  on  the  floor  outside  his 
door.  His  more  important  work  was  done  in  the  morning 
hours ;  for  him  "  great  business  must  be  wrought  ere  noon  " ; 
private  consultations  were  relegated  to  the  later  hours  of  the 
day.  His  power  immediately  to  grasp  the  significance  of  situa- 
tions, his  ability  to  make  quick  decisions,  his  unfailing  tact 
and  discretion,  together  with  his  wide  sympathies  and  his 
lively  sense  of  humor  made  it  a  pleasure  to  transact  business 
with  him.  His  ideals  he  kept  ever  before  him  and  was  am- 
bitious to  realize  them,  and  these  ideals  and  this  ambition 
were  alluring  also  to  those  whom  he  led.  Much  might  be 
written,  were  there  space,  of  the  ways  in  which  he  overcame 
obstacles  and  met  important  emergencies,  of  the  motives  he 
appealed  to  when  he  desired  to  excite  men  to  action  or  to 
arrive  at  a  decision,  and,  in  general,  of  those  traits  of  character 
that  act  "  directly  by  presence,  and  without  means,'^  or  what 
is  sometimes  called  "  personal  magnetism."  Many  of  the 
qualities  that  make  for  successful  management,  though  easy 
enough  to  recognize  when  they  exist,  are  difficult  of  analysis 
and  perplexing  to  the  understanding.  Some  men  are  able  to 
secure  control  without  contest ;  "  whether  they  stand  or  walk 
or  sit  or  whatever  thing  they  do,"  they  can  place  men  under 
their  power.  Of  such  character-control  and  of  prestige-control 
Professor  Osier  had  his  full  share.  But,  more  important  than 
these,  he  had  grasped,  as  it  were  intuitively,  the  newer  prin- 
ciples of  association  and  of  group  organization.  A  man  of 
many  selves,  he  could  enter  into  helpful  association  with  many 


As  Chief  of  a  Medical  Clinic  31 

different  groups,  letting  his  mind  interact  with  the  other 
minds  of  each  group  for  the  purpose  of  arriving  at  ideas,  feel- 
ings and  impulses  in  common.  More  than  most  he  had  learned 
how  to  live  with  other  men,  to  discuss  without  antagonism,  to 
secure  co-operation  by  the  subtle  psychic  process  of  reciprocal 
penetration.  In  this  lay  the  secret  of  his  co-ordinating  power. 
He  knew  not  only  how  to  bring  the  various  activities  of  his 
clinic  into  proper  relation  with  one  another,  but  also  how  to 
link  the  clinic  with  other  departments  of  the  university,  with 
the  medical  profession,  with  the  public  near  and  far,  and 
with  national  and  international  associations  of  different  kinds. 
Through  his  power  as  an  organizer  and  as  a  manager  Professor 
Osier  might,  then,  have  truthfully  said,  as  did  one  of  old,  "  I 
magnify  mine  office.^^  And  it  is  precisely  capacity  for  such 
magnification  of  office  that,  along  with  ability  to  plan  and  to 
direct,  is  a  distinguishing  criterium  of  the  superior  executive. 


SOME  OF  THE  EAELY  MEDICAL  WORK  OF  SIR 
WILLIAM  OSLER 

By  W.  T.  Councilman 

William  Osier,  the  son  of  the  Rev.  F.  L.  Osier,  was  born 
in  Tecumseh,  Ontario,  in  1849.  He  was  one  of  a  large  family, 
and  his  ancestors  were  a  vigorous,  long-lived  race.  He  gradu- 
ated from  Trinity  College,  Toronto,  in  1868,  began  the  study 
of  medicine  in  the  University  of  Toronto,  and  after  two  years 
went  to  McGill  University,  Montreal,  where  he  received  the 
M.  D.  degree  in  1872.  From  1872  to  1874  he  studied  abroad, 
working  in  the  various  London  clinics,  in  the  laboratory  of 
University  College,  London,  and  in  the  laboratories  and 
clinics  of  Berlin  and  Vienna.  He  came  in  contact  with  many 
eminent  men,  studied  methods  of  work  and  of  teaching,  and 
the  influence  of  this  period  of  European  study  is  seen  in  his 
after  career.  In  1873  he  obtained  the  licentiate  of  the 
College  of  Physicians  of  London,  in  1878  he  was  made  a 
member  of  the  college,  and  in  1884  was  elected  to  the  fellow- 
ship. In  1874  he  returned  to  Montreal,  was  made  lecturer 
on  the  institutes  of  medicine,  and  shortly  afterwards  was 
given  the  professorship.  Under  the  institutes  of  medicine 
were  comprised  the  courses  in  physiology  and  pathology,  the 
latter  limited  to  20  lectures.  At  the  end  of  1874  he  was  made 
physician  to  the  Small-pox  Hospital,  and  in  the  following  year, 
owing  to  the  interest  which  he  showed  in  comparative  anatomy, 
the  professorship  of  helminthology,  in  the  Veterinary  School 
of  the  university,  was  taken  into  his  already  full  hands.  I 
shall  discuss  here  only  his  early  work,  extending  through  the 
first  four  years  of  the  Montreal  period. 

Beyond  the  bare  facts,  we  know  but  little  of  his  early 
education.  In  his  various  writings  there  are  only  scanty 
allusions  to  it  save  in  the  Toronto  address,  in  which  he  men- 
tions three  men  who  were  his  early  teachers  and  to  whom  he 
3  33 


34  Sir  William  Oslkr,  Bakt. 

says  he  owes  everything  he  has  attained  in  life.  These  were 
the  Eev.  W.  A.  Johnson,  of  Weston,  Ontario;  Dr.  James 
Bovell,  of  Trinity  College,  later  professor  of  the  institutes  of 
medicine  in  Toronto  University,  and  Prof.  Eobert  Palmer 
Howard,  of  Montreal. 

I  have  been  able  to  learn  but  little  of  the  Rev.  W.  A.  John- 
son, but  it  is  evident  that  he  was  one  of  the  many  clergymen  of 
the  Church  of  England  who  have  sought  in  various  scientific 
pursuits  a  wider  range  of  intellectual  activity  than  is  given  by 
their  profession.*  I  have  gained  this  conception  of  the 
Eeverend  Johnson  from  two  passages  in  the  early  writings  of 
Dr.  Osier.  In  the  first  article  published  by  him  (Canadian 
Diatomaceae,  Canadian  N'aturalist,  1870)  when  he  was  a 
student  in  Toronto,  he  thanks  him  for  assistance  in  the  use  of 
books  and  microscopical  apparatus.  In  this  article  there  is  an 
admirable  description  of  the  structure,  mode  of  division  and 
propagation  of  the  diatom,  which  is  evidently  based  upon 
observation.  The  mode  of  motion  of  the  organisms  is  dis- 
cussed and  he  is  inclined  to  accept  the  hypothesis  advocated  by 

*  The  Scottish  Church  has  produced  very  few  of  these  men, 
and  they  have  been  rare  in  America.  However  singular  this  may 
seem,  the  reasons  are  obvious.  The  clergy  of  the  Church  of 
England  possessed  a  liberal  education,  and  the  taking  of  orders 
did  not  demand  any  extensive  preparation  for  the  examinations. 
Most  of  them  had  an  assured  living  in  pleasant  country  surround- 
ings, and  the  dogma  was  simple,  fixed,  and  did  not  admit  of  con- 
troversy. Proselyting  was  not  actively  pursued  in  the  English 
church,  and  the  souls  of  their  simple  parishioners  were  not  a 
serious  care.  They  must  have  found  little  intellectual  stimulus 
in  the  society  of  the  country  squires,  and  many  of  them  were 
perforce  driven  into  the  study  of  botany  and  other  branches  of 
natural  science.  The  Scottish  church,  on  the  other  hand,  de- 
manded long  and  arduous  preparation  for  the  ministry,  and  most 
of  its  members  did  not  have  the  background  ol  a  liberal  educa- 
tion. Like  the  Scottish  character,  the  church  was  a  fierce, 
aggressive  force,  its  dogma  logical  and  uncompromising,  and 
its  defence  and  extension  involved  a  constant  controversy,  which 
left  little  time  for  the  calm  study  of  nature.  In  this  country 
the  conflicts  of  the  sects  give  suflBcient  intellectual  diversion. 


Early  Medical  Work  35 

Professor  Schultze,  of  Bonn.  At  the  close  he  gives  a  list  of 
105  diatoms  which  he  had  collected  and  classified,  giving  also 
the  localities  where  they  were  found  and  their  frequency.  He 
must  have  been  for  a  long  time  interested  in  the  subject  and 
the  organisms  were  collected  over  an  extensive  area.  He  gives 
credit  to  Mr.  Johnson  for  having  given  him  several  of  the 
specimens.  He  refers  also  to  another  clergyman,  the  Eev.  Mr. 
Eeade,  who  had  invented  a  prism  by  the  use  of  which  the 
shell  markings  could  be  studied  to  better  advantage,  and  which 
was  loaned  to  him  by  Professor  Bovell.  The  article  shows 
familiarity  with  the  microscope  and  capacity  to  use  literature. 
The  second  reference  to  Mr.  Johnson  I  have  found  in  an 
article  12  years  later  (On  Canadian  Fresh  Water  Polyzoa, 
Canadian  Naturalist,  1882)  which  was  read  before  the  Natural 
History  Society.  There  is  here  also  an  admirable  description 
of  the  organisms  with  the  differentiation  of  the  species,  but  its 
main  interest  is  in  showing  how  early  Osier — probably  through 
the  influence  of  Mr.  Johnson — became  interested  in  the  study 
of  nature.  "  In  the  summer  of  1867,  during  a  visit  of  my 
friend,  the  Eev.  W.  A.  Johnson,  of  Weston,  I  showed  him  the 
masses  (the  gelatinous  aggregates  of  the  Pectinatella  mag- 
nifica  of  Leidy)  and  we  agreed  to  subject  them  to  examination 
by  the  microscope,  not  having  any  idea  as  to  their  real  nature. 
Judge  of  our  delight  when  we  found  the  whole  surface  of  the 
jelly  was  composed  of  a  collection  of  tiny  animals  of  surpassing 
beauty,  each  of  which  thrust  out  to  our  view  in  the  zoophyte 
trough  a  crescent-shaped  crown  of  tentacles.'^  A  foot-note 
speaks  of  another  clergyman,  the  Eev.  Thomas  Hincks,  as  the 
distinguished  authority  on  British  polyzoa. 

His  second  teacher,  Dr.  James  Bovell,  seems  to  have  been 
an  interesting  character.  He  was  born  in  Barbados  in  1817, 
went  to  England  in  1834,  studied  at  Guy's  Hospital,  and  took 
the  medical  degree  in  Glasgow  in  1838.  He  then  went  to 
Dublin,  studied  under  Stokes  and  Graves  for  several  years  and 
after  a  severe  attack  of  typhus  fever,  against  the  advice  of  his 
friends,  who  predicted  a  brilliant  medical  career,  returned  to 
Barbados.    From  there  he  went  to  Canada  in  1848 ;  took  part 


36  Sir  William  Osler,  Bart. 

in  the  establishment  of  the  medical  faculty  of  Trinity  College, 
became  dean  and  professor  of  the  institutes  of  medicine,  and 
also  professor  of  natural  theology.  After  the  disruption  of 
this  medical  school  he  held  a  similar  medical  position  in 
Toronto  University.  In  1870  he  returned  to  the  West  Indies 
where  he  remained  until  his  death.  While  there  he  took 
orders  in  the  English  Church  and  published  a  book  on  Natural 
Theology.  He  was  regarded  as  an  impractical,  improvident 
man,  was  loved  by  his  students  and  friends  and  took  great 
delight  in  metaphysical  discussions.  Osier  came  under  his 
influence  in  Trinity  College,  and  in  Toronto  University,  and 
he  has  dedicated  to  him  the  first  pathological  report  of  the 
Montreal  General' Hospital.  It  is  not  improbable  that,  through 
these  two  men  and  the  atmosphere  of  his  home.  Osier  acquired 
the  interest  in  biblical  and  ecclesiastical  literature  which  was 
such  a  prominent  characteristic  of  his  later  life. 

The  third  of  these  men  was  Dr.  Robert  Palmer  Howard, 
professor  of  medicine  in  McGill  University,  whom  Osier  speaks 
of  as  his  second  father.  He  was  a  greatly  respected  teacher 
and  practitioner  of  medicine  and  exerted  a  wide  influence,  but 
he  was  not  a  prolific  writer. 

While  in  London,  Osier  published  two  articles  from  the 
laboratory  of  University  College.  The  first,  "  On  the  Action 
of  Atropia,  Physostigma,  and  Curare  on  the  Colorless  Blood 
Corpuscles,^^  was  read  before  the  Eoyal  Microscopical  Society 
in  1873,  and  published  in  its  journal.  Such  a  paper  as  this 
was  rather  unusual  at  the  meetings  of  the  society  which  were 
mostly  taken  up  with  descriptions  of  microscopes,  methods  of 
preparation  of  microscopic  objects,  etc.  The  object  of  the 
investigation  was  to  determine  whether  the  antagonism  be- 
tween atropia  and  physostigma,  which  Fraser  had  shown  to 
exist,  could  be  demonstrated  in  the  behavior  of  colorless  cor- 
puscles under  the  microscope,  and  the  result  was  negative.  It 
was  interesting  to  find  in  the  same  volume  with  the  paper  of 
Dr.  Osier  a  long,  interesting  and  scathing  review  of  Bastian's 
Beginnings  of  Life  which  had  just  appeared. 


Early  Medical  Work  37 

The  second  article,  "An  Account  of  Certain  Organisms 
Found  in  the  Liquor  Sanguinis/'  was  published  in  1874, 
appearing  in  the  Proceedings  of  the  Eoyal  Society.  This 
forms  one  of  the  most  important  of  Dr.  Osier's  contributions 
to  medicine  and  demands  a  more  detailed  description  in  order 
to  do  justice  to  the  originality  shown  in  this  article.  From 
the  massive  literature  on  the  subject  four  articles  may  be 
singled  out,  each  of  which  was  an  important  contribution  to 
knowledge.  In  1865,  in  the  article  of  Max  Schultze  on  the 
blood,  certain  bodies  afterwards  known  as  blood  plates  were 
for  the  first  time  adequately  described;  the  second  was  the 
article  by  Osier,  the  third  by  Bizzozero  in  1882,  in  which  he 
gave  a  new  method  for  their  study  and  showed  the  part  they 
played  in  thrombus  formation,  and  the  fourth  by  J.  H.  Wright 
in  1910,  who  demonstrated  their  histogenesis.  The  name 
blood  plates,  given  to  the  bodies  by  Bizzozero,  has  been  adopted. 
It  would  be  difficult  to  say  who  first  saw  and  described  them. 
At  this  period  the  fresh  unstained  blood  was  being  actively 
examined  by  many  with  a  view  to  the  discovery  of  micro- 
organisms which  might  be  the  cause  of  infectious  diseases. 
Zimmermann,  in  Eust's  Magazin  f .  d.  gesammte  Heilkunde  in 
1846,  and  again  in  Virchow's  Archives,  Vol.  18,  1860,  saw  and 
described  the  bodies  as  small  globules  which  he  regarded  as  the 
elementary  corpuscles  from  which  the  blood  cells  develop,  but 
his  description  was  very  vague  and  he  did  not  sharply  separate 
them  from  other  granules  in  the  blood.  The  very  remarkable 
article  on  the  blood  cells  by  Max  Schultze  conceals  by  its  title 
"  Ein  Heizbare  Objecttisch  und  seine  Verwendung  bei  Unter- 
suchungen  des  Blutes "  (Arch.  f.  Mikro.  Anatomic,  Bd.  I, 
1865),  the  subject  of  the  article  much  better  than  usually 
happens,  in  spite  of  the  ingenuity  which  is  often  displayed  in 
doing  this.  After  a  description  of  the  varieties  of  the  white 
corpuscles,  the  accuracy  of  which  excites  our  admiration  even 
now,  he  says  "  In  the  blood  no  constituent  is  without  impor- 
tance, and  in  conclusion  I  will  call  attention  to  a  normal  form 
constituent  of  the  human  blood  which  up  to  the  present  has 
been  entirely  neglected.    I  find  in  my  blood  and  in  the  blood 


38  Sir  William  Osler,  Bakt. 

of  numerous  persons  of  different  ages  more  or  less  abundant, 
irregular  masses  of  colorless  globules,  the  masses  varying  in 
size  according  to  the  number  of  globules  which  compose  them. 
The  globules  themselves  are  from  one  to  two  micra  in  diameter 
and  also  occur  separately  in  the  blood.  I  have  found  three, 
four  and  even  hundreds  joined  together,  forming  plaques  of 
irregular  size,  80  or  more  micra  in  diameter.  These  structures, 
on  account  of  their  irregular  size  and  shape,  give  the  impres- 
sion of  broken  up  tissue  elements.''  * 

This  was  the  condition  when  young  Osier  was  probably  given 
the  subject  for  investigation  in  the  laboratory.  He  showed 
that  these  granular  masses  of  Schultze  were  not  present  in  the 
circulating  blood,  but  were  formed  at  the  moment  of  examina- 
tion by  a  rapid  aggregation  of  the  single  bodies.  He  showed 
this  by  microscopic  study  of  the  blood,  and  also  by  the  direct 
examination  in  salt  solution  of  small  clippings  from  the 
connective  tissue  of  the  rat  in  which  he  found  the  single  bodies 
and  not  the  masses  of  them,  within  the  small  blood  vessels. 
He  also  showed  that  the  conception  of  their  presence  in  the 
blood  in  aggregations  was  untenable  because  the  masses  could 
not  pass  through  the  capillaries.  He  described  the  small 
bodies  as  exhibiting  amoeboid  activity  and  saw  filaments  form 
in  connection  with  them,  which  were  probably  fibrin.  The 
article  is  admirable,  clear  and  concisely  expressed,  with  full 
literature  references.  The  next  reference  to  the  blood  plates 
is  in  an  article  "Infectious  Endocarditis"  (Seguin's  Arch., 
1881),  and  here  he  anticipates  Bizzozero's  view  of  the  part 
they  play  in  thrombus  formation.  ^'  In  one  case  of  mitral 
stenosis  a  fresh  vegetation  when  teased  showed  many  closely 
packed  spherules,  some  of  which  were  larger  than  those  met 

*  I  have  quoted  from  this  article  for  one  reason  because  it  was 
used  as  a  reference  in  the  course  of  physiology  given  by  Newell 
Martin  in  1878,  and  the  plate  when  I  opened  the  volume  appeared 
as  a  familiar  friend.  No  one  appreciated  more  than  did  Doctor 
Osier  the  importance  of  familiarizing  students  with  the  original 
sources  of  knowledge,  and  this  was  always  done  in  Martin's 
laboratory. 


Early  Medical  Work  39 

with  in  the  ulcerative  form.  [These  were  the  masses  of 
micrococci.]  I  was  greatly  struck  with  the  resemblance  which 
certain  of  these  bodies,  in  this  instance,  bore  to  the  individual 
elements  of  Schnitzels  granule  masses — those  peculiar,  granu- 
lar clumps  common  in  the  blood  of  some  animals  and  of 
impoverished  *  persons.^^  In  1882  there  appeared  a  further 
article,  "Ueber  den  dritten  Formbestandteil  des  Blutes,"  in 
the  Centralblatt  f.  d.  med.  Wissensch.,  ^o.  30,  in  which  he 
emphasized  the  part  they  played  in  the  formation  of  thrombi 
and  a  final  article  "  On  the  Third  Corpuscle  of  the  Blood," 
Medical  News,  1883,  a  rather  popular  presentation  of  the 
subject. 

Osier  returned  to  Montreal  in  1874,  bringing  to  his  future 
work  a  remarkable  equipment.  He  was  25  years  old,  possessed 
a  vigorous  healthy  body,  and  a  well-trained  mind.  His  family 
was  well  and  favorably  known  in  the  community,  which  gives 
no  small  advantage  in  a  conservative  society.  He  had  received 
a  valuable  education,  probably  more  valuable  though  different 
from  that  which  men  are  now  receiving.  He  had  come  into 
close  contact  with  men  of  high  ideals  and  good  methods  of 
work,  he  possessed  the  methods  by  which  knowledge  is  obtained 
and  had  already  made  important  contributions  which  gave  him 
a  reputation.  He  further  had  enthusiasm  and  the  art  of 
inspiring  this  in  his  students,  native  kindness  of  heart,  a 
candid,  open  disposition,  a  great  capacity  not  only  for  making 
friends,  but  for  arousing  the  feeling  of  affection,  and  a  fine 
sense  of  humor,  never  used  to  hurt,  which  made  him  a  sought 
and  delightful  companion.  He  wrote  well  and  easily,  ex- 
pressed himself  simply  and  clearly,  leaving  no  doubt  as  to  the 
meaning,  and  the  matter  was  well  arranged.  In  spite  of  the 
number  of  these  early  articles,  they  all  show  care  in  prepara- 
tion. He  had  also  great  capacity  for  work,  and  ambition,  with 
a  definite  end  in  view.     For  such  a  man  there  are  always 

*  Osier  did  not  usually  use  such  ambiguous  expressions ;  tlie 
presence  of  such  masses  in  the  blood  might  be  regarded  as  one 
of  the  disadvantages  of  economic  poverty. 


40  Sir  William  Osler,  Bart. 

opportunities  waiting,  and  Osier  found  them  in  Montreal,  as 
he  would  have  found  them  anywhere,  even  with  his  friend 
Bo  veil  in  Nevis. 

In  the  latter  part  of  1874,  in  addition  to  his  position  in  the 
university,  he  was  made  physician  to  the  Small-pox  Hospital, 
which  gave  him  opportunities  for  clinical  study  and  an  interest 
in  the  disease  which  he  has  always  retained.  With  the  salary 
which  the  position  gave  he  purchased  microscopes  for  teaching 
in  the  medical  school.  In  1876  he  published  in  the  Canadian 
Medical  and  Surgical  Journal  three  articles  on  small-pox: 
(1)  "The  Initial  Eashes  of  Small-pox '';  (2)  "On  Hemor- 
rhagic Small-pox ^^;  (3)  "A  Form  of  Hemorrhagic  Small- 
pox/^ which  are  valuable  contributions  to  our  knowledge  of 
the  disease.  They  show  accurate  observation,  good  clinical 
judgment  and  a  marked  power  of  differentiation  of  conditions 
both  clinical  and  pathological.  He  had  studied  skin  diseases 
with  Tilbury  Fox  in  England,  and  the  influence  of  these 
studies  is  shown  here.  It  was  an  important  work  for  him,  for 
in  the  Small-pox  Hospital  he  first  acquired  the  power  of  close 
observation  of  skin  lesions  and  the  ability  of  differentiation 
and  description  which  was  afterwards  such  a  marked  feature 
in  his  clinical  work. 

A  very  interesting  article  appeared  in  the  same  journal  in 
1876,  "  On  the  Pathology  of  Miner's  Lung.^'  It  is  based  upon 
the  examination  of  the  lungs  of  a  coal-miner  who  died  in  the 
Small-pox  Hospital,  and  in  whom  the  condition  was  very 
marked,  and  several  other  cases  showing  various  degrees  of  the, 
same  condition.  It  is  a  good  piece  of  work,  shows  much 
originality,  and  is  to  be  regarded  as  the  best  article  in  English 
on  the  disease,  which  was  first  described  by  Pearson  in  1813. 
In  this  article  for  the  first  time  the  large  mononuclear  phago- 
cytes were  differentiated  from  the  smaller  corpuscles,  and 
Osier  showed  that  the  large  cells  were  those  most  actively  con- 
cerned in  the  phagocytosis  of  the  carbon.  He  says :  "  One 
most  curious  specimen  was  observed.  On  an  elongated  piece 
of  carbon  three  cells  were  attached,  one  on  either  end  and  a 
third  in  the  middle,  so  that  the  whole  had  a  striking  resem- 


Early  Medical  Work  41 

blance  to  a  dumb-bell.  I  could  hardly  credit  this  at  first,  until 
by  touching  the  top  cover  and  causing  the  whole  to  roll  over, 
I  quite  satisfied  myself  that  the  ends  of  the  rods  were  com- 
pletely embedded  in  the  corpuscles  and  the  middle  portion 
entirely  surrounded  by  another/^  His  description  of  the 
position  of  the  carbon  in  the  lungs  and  its  relation  to  the 
lymphatics  is  accurate.  He  gives  a  figure  of  a  microscopic 
piece  of  coal  which  was  found  and  which  showed  the  scalari- 
f orm  tissue  of  ferns,  thus  proving  its  origin,  and  another  piece 
with  two  holes  representing  the  dotted  cells  of  firwood.  In 
conclusion,  there  is  an  experimental  study  of  the  effect  of 
foreign  bodies  in  the  tissue  made  by  the  injection  of  india  ink 
into  the  axillae  and  lungs  of  kittens. 

The  study  of  the  blood  plates  gave  him  a  familiarity  with 
blood  examination  which  he  utilized  in  the  study  of  anaemia, 
and  there  are  several  papers  on  this  in  1877.  The  first  of 
these,  "  A  Case  of  Progressive  Pernicious  Anaemia,"  was  pub- 
lished in  association  with  Dr.  Gardner  in  the  Canadian  Medi- 
cal and  Surgical  Journal.  It  is  probable  that  Osier  wrote  the 
paper  and  was  responsible  for  the  blood  examination  and  the 
description  of  the  autopsy,  which  showed  the  usual  conditions 
found  in  the  disease.  It  is  a  good  type  of  medical  paper,  the 
descriptions  of  the  blood  and  of  the  marrow  changes  are 
accurate,  and  the  relation  between  the  blood  changes  and  the 
marrow,  which  had  been  described  by  Cohnheim  in  the  same 
year,  is  confirmed.  An  abstract  of  this  article,  with  detailed 
measurements  of  the  various  blood  cells  "  Ueber  die  Beschaf- 
fenheit  des  Blutes  und  Knochenmarkes  in  d.  progressiven 
pernicioser  Anamie  "  was  published  in  the  Centralblatt  f .  d. 
med.  Wissensch.,  1877,  No.  15,  and  a  second  article  in  the 
same  journal  on  the  study  of  a  second  case.  Another  article 
on  the  same  subject,  in  which  he  was  associated  with  Dr.  Bell, 
appeared  in  the  Transactions  of  the  Canadian  Medical  Asso- 
ciation, and  here  he  gives  Addison  the  credit  for  having  first 
recognized  and  described  the  disease  under  the  name  of 
idiopathic  anaemia.  There  is  a  final  article  in  the  following 
year,  "  Entwickelung  von  Blutkorperchen  im  Knochenmark 


42  Sir  William  Osler,  Bart. 

bei  pemicioser  Anamie/^  Centralblatt  f.  d.  med.  Wissensch., 
1878,  in  which  he  confirms  Neumann's  results  of  the  study  of 
blood  formation  in  the  marrow. 

During  this  period  also  he  wrote  a  number  of  articles  on 
comparative  pathology,  the  first  on  "  Verminous  Bronchitis  in 
Dogs,  with  Description  of  a  New  Parasite  "  was  published  in 
the  Veterinarian,  London,  1877.  He  found  this  parasite  in 
the  bronchi  in  an  epidemic  among  dogs  in  Montreal.  He  gives 
an  accurate  description  of  the  parasite,  and  the  points  of 
differentiation.  It  has  been  accepted  as  an  original  descrip- 
tion and  credited  to  him,  the  name  Filaria  osleri  being  one  of 
its  synonyms.  The  only  mistake  he  made  was  in  classing  the 
organism  among  the  strongyli  and  not  the  filariae,  the  main 
difference  being  that  the  strongylus  is  oviparous  and  the  para- 
site described  by  him  produces  living  embryos.  The  lobular 
pneumonia  which  he  found,  associated  with  the  presence  of 
the  parasites  in  the  bronchi,  he  referred  to  the  inhalation  of 
inflammatory  products  produced  by  them.  The  paper  closes 
with  a  discussion  of  the  mode  of  infection  which  he  thought 
was  by  the  direct  inhalation  of  the  dried  embryos  and  it  would 
have  been  more  valuable  had  he  subjected  this  theory  to  experi- 
mental test.  There  is  also  a  paper  on  Trichina  spiralis 
(Canadian  Journal  of  Medical  Sciences,  1876)  which  gives 
a  good  description  of  the  disease  and  the  life  history  of  the 
organism,  but  which  does  not  add  anything  new,  and  there  are 
a  number  of  other  articles  which  appeared  at  intervals  up  to 
the  time  he  left  Montreal  for  Philadelphia.  In  the  last  article, 
"  An  Investigation  into  the  Pork  Supply  of  Montreal,"  which 
was  conducted  in  association  with  one  of  his  students  in  the 
veterinary  school,  A.  W.  Clement,  who  was  afterwards  well 
known  in  the  early  days  of  the  pathological  laboratory  of  The 
Johns  Hopkins,  he  speaks  of  having  made  900  autopsies  in 
Montreal,  in  four  of  which  trichina  were  found. 

There  are  two  interesting  addresses  in  the  period.  The  first 
was  to  the  graduating  class  in  medicine  in  1875.  It  was  prob- 
ably the  habit  of  the  faculty  to  place  the  burden  of  such  an 
address  upon  the  youngest  member.    Eeading  over  this  address. 


Early  Medical  Work  43 

one  is  conscious  that  Osier  had  very  little  interest  in  it.  Prob- 
ably he  looked  over  other  addresses  given  on  similar  occasions 
and  they  must  have  been  a  very  poor  lot.  He  gives  the  usual 
good  advice  to  the  students,  telling  them  to  keep  up  their 
reading,  to  observe  patients  well,  and  even  at  this  early  period 
introduces  Sir  Thomas  Browne,  but  he  does  not  use  him 
effectively.  It  seems  by  far  the  worst  thing  he  ever  published ; 
there  is  no  trace  of  humor  in  it,  and  no  indication  of  the 
remarkable  power  he  showed  in  his  later  addresses. 

The  second  address  is  of  a  totally  different  character.  It 
represents  much  more  work  and  care  in  preparation,  as  though 
Osier  had  concluded  that  giving  addresses  was  to  be  part  of  his 
future  work  and  that  they  should  be  good.  There  are  a  num- 
ber of  quotations,  many  of  them  apt,  the  usual  good  advice  to 
students,  and  some  really  inspiring  sentiments,  well  expressed. 
For  instance,  "  You  will  have  moments  when  the  way  appears 
rugged,  and  the  outlook  dark,  but  never  fear;  others  have 
succeeded  in  the  face  of  the  same  difficulties,  and  with  patience 
and  perseverance  you  will  do  so  too.  Banish  the  future.  Live 
only  for  the  hour  and  its  allotted  work.  Think  not  of  the 
amount  to  be  accomplished,  the  difficulties  to  be  overcome,  or 
the  end  to  be  attained,  but  set  earnestly  at  the  little  task  at 
your  elbow,  letting  that  be  sufficient  for  the  day,  for  surely  our 
plain  duty  is  ^  not  to  see  what  dimly  lies  at  a  distance,  but  to 
do  what  lies  clearly  at  hand.^  ^'  It  is  difficult  to  give  a  student 
better  advice  than  this.  Of  the  family  physician  he  says  "  But 
while  the  soldier  and  the  statesman  win  honor  and  fame,  the 
family  physician  will  draw  to  himself  the  love  and  gratitude 
of  manifold  hearts;  he  will  have  no  enemies,  martial  or 
political;  and  his  labors,  if  directed  by  a  wise  and  prudent 
skill,  will  be  for  the  welfare  and  benefit  of  all." 

From  1872  to  1878  was  a  great  period  in  medicine;  it  Just 
preceded  the  bacteriological  era  in  which  the  nature  of  infec- 
tion was  established;  Pasteur  had  completed  his  studies  on 
fermentation  and  the  silk-worm  disease  and  was  in  the  midst 
of  his  revolutionary  work  on  anthrax;  Koch,  an  obscure 
country  physician,  was  beginning  his  studies  on  bacteria  and 


44  Sir  William  Osler,  Bart. 

developing  the  methods  which  made  their  scientific  study 
possible;  Virchow  was  at  the  height  of  his  fame;  Cohnheim 
and  Weigert  had  begun  in  Breslau  and  in  Leipsie  their  remark- 
able work ;  a  new  university  in  Strasburg  had  just  been  estab- 
lished which  became  famed  through  its  products ;  physiology, 
in  England  and  under  Ludwig  in  Leipsie,  had  taken  a  new 
life;  Lister  in  England  was  in  the  midst  of  the  work  which 
revolutionized  surgery;  the  modern  medical  clinic  was  slowly 
being  established,  and  medicine  was  becoming  scientific,  its 
procedures  based  upon  knowledge  and  not  conjecture;  new 
ideals  and  methods  in  medical  teaching  were  being  everywhere 
introduced ;  America  was  feeling  the  enormous  stimulus  of  the 
promise  given  in  the  establishment  of  The  Johns  Hopkins 
University.  Osier  was  under  the  stimulus  of  all  the  new  life. 
He  could  easily  have  become  a  great  scientist,  but  he  chose  the 
path  which  led  to  the  formation  of  the  great  clinician  which 
he  became ;  a  worthy  associate  of  the  great  men  who  have  made 
English  medicine  famous. 


OSLEE  AS  A  PATHOLOGIST 
By  William  G.  MacCallum 

The  statement  may  be  safely  ventured  that  no  clinician  in 
English-speaking  countries  has  had  at  his  command  such  a 
wide  and  detailed  knowledge  of  morbid  anatomy  as  Osier. 
There  may  be  different  opinions  as  to  the  reasons  for  his  great- 
ness as  a  teacher,  as  a  man  among  men  and  in  other  ways,  but 
hardly  more  than  one  opinion  as  to  the  foundation  of  his 
greatness  as  a  clinician. 

In  the  two  small  volumes  of  Pathological  Eeports  printed 
at  the  McGill  University,  in  a  complete  collection  of  reprints 
of  his  papers  beginning  in  1877,  and  in  the  first  edition  of  his 
Practice  of  Medicine,  the  development  of  his  knowledge  of 
pathological  anatomy  may  be  clearly  traced.  Throughout 
there  is  no  diminution  in  his  keen  enthusiasm  and  little  change 
in  the  character  of  his  interests,  but  there  is  an  extraordinary 
advance  in  the  clarity  of  his  ideas  keeping  pace  with  the  dis- 
coveries of  the  European  and  other  workers  in  the  field  of 
pathology. 

During  a  period  of  more  than  40  years — years  that  have 
witnessed  the  most  phenomenal  advances  in  medicine — his 
attention  was  very  largely  devoted  to  these  studies  which  were 
constantly  maintained  as  the  basis  of  his  more  purely  clinical 
work. 

Osier's  training  lay  not  in  chemistry — the  growth  of  bac- 
teriology found  him  a  spectator  and  experimental  methods 
seem  to  have  had  little  attraction  for  him.  ISTor  did  he  attempt 
any  protracted  researches  in  pathology  for  its  own  sake.  In- 
stead his  interest  was  and  has  always  been  in  the  observation  of 
rather  gross  and  striking  anatomical  alterations,  usually  on 
account  of  the  symptoms  which  they  produced  and  not  with 
the  aim  of  investigating  their  minute  details  or  their  ultimate 

45 


46  Sir  William  Osler,  Bart. 

causes.  In  all  this  he  has  shown  himself  critical  and  sane  and 
quite  unwilling  to  pursue  what  seemed  a  fantastic  theory 
unless  convinced  by  definite  proofs.  He  was  skeptical  of  the 
malarial  organisms  of  Laveran  for  a  time  until  he  became 
familiar  with  them  himself  and  demonstrated  them  in  this 
country.  He  would  not  believe  that  the  micrococci  found  in 
acute  endocarditis  were  anything  more  than  accidental  in- 
vaders until  he  had  convinced  himself  by  actual  studies  of  the 
valves. 

But  in  his  early  days  he  did  not  wait  for  others  to  unearth 
new  facts.  He  pressed  ahead  alone  in  the  investigation  of 
unexplained  phenomena  and  was  perhaps  the  first  to  see  clearly 
the  blood  platelet  which  he  described  in  1874  as  the  third 
corpuscle  of  the  blood. 

He  was  early  in  the  field  with  his  studies  of  the  bone-marrow 
in  pernicious  angemia  and  evidently  recognized  megaloblasts 
and  other  cells  at  a  time  when  such  recognition  must  have  been 
very  difficult. 

But  from  the  beginning  he  appears  to  have  been  more  readily 
interested  in  the  physical  aspects  of  morbid  anatomy,  especially 
in  so  far  as  there  could  be  traced  a  chain  of  events.  In  the 
first  volume  of  the  McGill  reports  he  describes  a  case  of 
idiopathic  hypertrophy  of  the  heart,  the  topography,  and  effects 
of  various  aneurysms,  cases  of  phthisis,  pneumonia,  cancer, 
ulcer  of  the  duodenum,  typhoid  fever  with  perforation,  incar- 
ceration of  the  ileum,  etc.  In  the  second  volume  is  found  a 
series  of  similar  miscellaneous  cases.  Some  of  these  were 
remarkable  as,  for  example,  the  instance  of  aneurysm  of  the 
hepatic  artery.  It  is  to  be  noted  that  even  in  his  discussion  of 
these  cases  he  showed  that  the  special  literature  of  foreign 
countries  was  quite  at  his  command.  He  met  with  a  case  of 
hypertrophic  cirrhosis  of  the  liver — the  first  in  his  experi- 
ence— and  while  he  was  studying  it  there  appeared  Hanot's 
thesis,  the  importance  of  which  in  relation  to  his  own  case  he 
recognized  at  once.  From  this  period  at  McGill  University 
where  he  performed  a  great  many  postmortem  examinations 
and  supervised  them  in  the  hands  of  students  he  acquired  much 


As  A  Pathologist  47 

of  his  familiarity  with  morbid  anatomy.  It  is  his  spirit  of 
serious  research  which  has  remained  to  inspire  the  splendid 
work  in  pathology  carried  on  ever  since  in  that  school  and  his 
preparations  formed  the  foundation  of  their  magnificent 
museum  of  pathological  anatomy. 

Osier  was  impressed  from  the  beginning  with  the  usefulness 
of  considering  together  a  group  of  series  of  similar  cases. 
There  is  something  statistical  about  this  plan,  but  since  no  two 
cases  of  any  disease  are  precisely  alike  in  all  details,  much 
light  comes  from  the  study  of  a  series.  This  method  may  be 
traced  through  the  work  of  his  later  years  and  in  that  of  all  of 
his  pupils.  It  is  apparent  in  all  the  papers  of  his  Philadelphia 
and  Baltimore  periods  and  reveals  his  careful  method  of  pre- 
serving minute  notes  on  all  he  saw,  for  some  of  the  recent 
studies  refer  back  to  cases  encountered  in  the  Montreal  days. 

Comprehensive  papers  on  endocarditis,  tuberculous  pleurisy, 
peritonitis,  pericarditis  and  abdominal  tumors,  followed  and 
later  similar  analyses  of  long  series  of  cases  of  typhoid  fever, 
meningitis,  erythema  multiforme,  Addison^s  disease,  myx- 
oedema,  splenic  anaemia,  malaria  and  many  other  conditions. 
In  these  there  is  a  sustained  and  constant  interest  in  the 
pathological  anatomical  changes,  but  rather  in  their  relation 
to  the  general  history  and  symptomatology  of  the  disease  than 
for  their  own  sake.  The  details  of  the  causes  and  development 
of  the  lesions  are  discussed  only  briefly,  but  an  important  out- 
come of  such  studies  was  in  several  instances  the  more  definite 
outlining  of  disease  entities  from  the  recognition  of  the  re- 
peated occurrence  of  the  same  group  of  symptoms  and  patho- 
logical alterations. 

This  has  long  been  the  first  great  step  in  the  study  of  disease 
and  it  is  for  this  reason  that  many  of  the  great  names  in 
medicine  are  associated  with  the  diseases  in  which  they  have 
been  the  first  to  discern  the  constancy  of  the  association  of 
several  features.  The  ability  to  see  these  relations  and  to 
connect  a  group  of  phenomena  with  a  common  cause  is  given  to 
few.  It  is  only  less  difficult  than  to  discover  the  hidden  cause 
of  disease. 


48  Sir  William  Osler,  Bart. 

On  the  other  hand,  with  diseases  well  recognized  by  every- 
one, Osier's  interest  in  new  manifestations  and  new  combina- 
tions of  symptoms  or  lesions  has  been  unfailing.  After  the 
long  period  of  observation  and  study  of  typhoid  fever  in  which 
he  associated  with  himself  all  the  men  on  his  staff  he  analyzed 
the  disease  from  every  point  of  view.  However,  in  these 
studies  only  the  grosser  anatomical  changes  are  considered  and 
there  was  no  special  advance  in  the  knowledge  of  the  bacteri- 
ology or  immunity  reactions  of  the  disease. 

Syphilis  has  always  claimed  much  of  his  attention  and 
interest,  although  he  has  written  little  on  it  except  in  the  form 
of  text-book  articles  and  papers  concerning  aneurysms.  Never- 
theless, the  multifarious  manifestations  of  this  disease  have 
formed  a  prominent  subject  in  his  teaching  and  he  believed 
that  there  was  much  in  the  statement  that  he  who  knew  all  of 
syphilis  knew  nearly  all  of  medicine. 

In  his  later  years  he  worked  no  longer  at  actual  dissections 
and  no  longer  studied  the  details  of  pathological  anatomy  with 
the  microscope,  but  he  never  slipped  into  that  state  of  con- 
fidence in  unaided  clinical  diagnosis  which  would  allow  him 
to  remain  away  from  the  autopsy  room.  Instead  he  came  there 
not  only  to  follow  minutely  the  dissection  of  cases  from  his  own 
hospital  service,  but  to  learn  what  he  could  from  those  belong- 
ing to  the  surgical  and  other  services.  His  presence  was  an  in- 
spiration that  led  us  to  great  efforts  toward  careful  work,  and 
his  long  experience  and  unfailing  memory,  which  enabled  him 
to  recall  the  conditions  found  in  a  whole  series  of  similar  cases, 
gave  us  a  background  upon  which  the  case  under  investigation 
stood  out. 

The  pathological  anatomy  of  his  text-book  is  of  this  quality 
and  it  is  for  that  reason  that  the  students  in  pathology  are  told 
to  read  it.  No  one  has  written  more  systematically,  or  more 
concisely  of  the  changes  underlying  the  manifestations  of 
disease ;  no  one  has  recognized  more  clearly  the  boundary  line 
between  the  known  and  the  unknown  or  sifted  more  judiciously 
and  unerringly  the  truth  from  error.  His  long  habit  of  con- 
sidering each  disease  on  the  basis  of  knowledge  gained  from 


As  A  Pathologist  49 

the  analysis  of  a  large  series  of  cases  has  allowed  him  to  esti- 
mate justly  the  relative  frequency  and  importance  of  each 
feature  and  to  state  them  in  the  most  helpful  and  orderly 
sequence.  This  clearness  of  vision  with  regard  to  the  actual 
natural  history  of  disease,  always  referring  to  a  well-remem- 
bered series  of  cases,  helped  to  make  his  teaching  a  memorable 
delight  to  his  students.  His  actual  contributions  to  our  knowl- 
edge of  pathology  are  many  and  important,  but  even  more 
valuable  to  the  science  of  medicine  in  general  is  his  example, 
in  that  he  has  built  his  clinical  medicine  solidly  on  a  founda- 
tion of  pathological  anatomy. 


1913. 


OSLER,  THE  TEACHER 
By  W.  S.  Thayer 

Observe,  record,  tabulate,  communicate. 

Use  your  five  senses.  The  art  of  the  practice  of  medicine  is 
to  be  learned  only  by  experience;  'tis  not  an  inheritance;  it 
cannot  be  revealed.  Learn  to  see,  learn  to  hear,  learn  to  feel, 
learn  to  smell,  and  know  that  by  practice  alone  can  you  become 
expert.  Medicine  is  learned  by  the  bedside  and  not  in  the  class- 
room. Let  not  your  conceptions  of  the  manifestations  of 
disease  come  from  words  heard  in  the  lecture  room  or  read 
from  the  book.  See,  and  then  reason  and  compare  and  control. 
But  see  first.  No  two  eyes  see  the  same  thing.  No  two  mirrors 
give  forth  the  same  reflection.  Let  the  word  be  your  slave  and 
not  your  master. 

Live  in  the  ward.  Do  not  waste  the  hours  of  daylight  in 
listening  to  that  which  you  may  read  by  night.  But  when  you 
have  seen,  read.  And  when  you  can,  read  the  original  descrip- 
tions of  the  masters  who,  with  crude  methods  of  study,  saw 
so  clearly. 

Record  that  which  you  have  seen ;  make  a  note  at  the  time ; 
do  not  wait.  "  The  flighty  purpose  never  is  o'ertook,  unless 
the  deed  go  with  it." 

Memory  plays  strange  pranks  with  facts.  The  rocks  and 
fissures  and  gullies  of  the  mountain-side  melt  quickly  into  the 
smooth,  blue  outlines  of  the  distant  panorama.  Viewed 
through  the  perspective  of  memor}^,  an  unrecorded  observation, 
the  vital  details  long  since  lost,  easily  changes  its  countenance 
and  sinks  obediently  into  the  frame  fashioned  by  the  fancy  of 
the  moment. 

Always  note  and  record  the  unusual.  Keep  and  compare 
your  observations.  Communicate  or  publish  short  notes  on 
anything  that  is  striking  or  new.  Do  not  waste  your  time  in 
compilations,  but  when  your  observations  are  sufiicient,  do 
not  let  them  die  with  you.  Study  them,  tabulate  them,  seek 
the  points  of  contact  which  may  reveal  the  underlying  law. 

51 


53  Sir  William  Osler,  Baet. 

Some  things  can  be  learned  only  by  statistical  comparison.  If 
you  have  the  good  fortune  to  command  a  large  clinic,  remem- 
ber that  one  of  your  chief  duties  is  the  tabulation  and  analysis 
of  the  carefully  recorded  experience. 

The  collection  and  study  of  your  own  observations  is  much, 
but  he  who  works  in  his  own  small  compartment  leads,  after 
all,  a  restricted  and  circumscribed  life.  Go  out  among  your 
fellows,  and  learn  of  them.  The  good  observer  is  not  limited 
to  the  large  hospital.  The  modest  country  doctor  may  furnish 
you  the  vital  link  in  your  chain,  and  the  simple  rural  prac- 
titioner is  often  a  very  wise  man. 

Eespect  your  colleagues.  Know  that  there  is  no  more  high- 
minded  body  of  men  than  the  medical  profession.  Do  not 
judge  your  confreres  by  the  reports  of  patients,  well  meanings 
perhaps,  but  often  strangely  and  sadly  misrepresenting.  Never 
let  your  tongue  say  a  slighting  word  of  a  colleage.  It  is  not 
for  you  to  judge.  Let  not  your  ear  hear  the  sound  of  your 
voice  raised  in  unkind  criticism  or  ridicule  or  condemnation 
of  a  brother  physician.  If  you  do,  you  can  never  again  meet 
that  man  face  to  face.  Wait.  Try  to  believe  the  best.  Time 
will  generally  show  that  the  words  you  might  have  spoken 
would  have  been  unjust,  would  have  injured  a  good  man,  and 
lost  you  a  friend,  and  then — silence  is  a  powerful  weapon. 

When  you  have  made  and  recorded  the  unusual  or  original 
observation,  or  when  you  have  accomplished  a  piece  of  research 
in  laboratory  or  ward,  do  not  be  satisfied  with  a  verbal  com- 
munication at  a  medical  society.  Publish  it.  Place  it  on 
permanent  record  as  a  short,  concise  note.  Such  communica- 
tions are  always  of  value. 

Mix  with  your  colleagues;  learn  to  know  them.  But  in 
your  relations  with  the  profession  and  with  the  public,  in 
everything  that  pertains  to  medicine,  consider  the  virtues  of 
taciturnity.  Look  out.  Speak  only  when  you  have  something 
to  say.  Commit  yourself  only  when  you  can  and  must.  And 
when  you  speak,  assert  only  that  of  which  you  know.  Beware 
of  words — they  are  dangerous  things.  They  change  color  like 
the  chameleon,  and  they  return  like  a  boomerang.  Do  you 
know  the  story  of  the  young  physician,  about  to  enter  practice, 


The  Teacher  53 

who  was  sent  by  his  father  to  his  old  friend,  Sir  William 
Stokes,  for  advice  ?  A  pleasant  conversation,  and,  at  the  door- 
way, a  last  word :  "  Charley,  don^t  say  too  much."  Then,  at 
the  gate,  a  voice :  *^  Charley,  come  back  a  minute ;  I'm  very 
fond  of  you,  my  boy ;  don^t  do  too  much." 

"  Don't  do  too  much."  Remember  how  much  you  do  not 
know.  Do  not  pour  strange  medicines  into  your  patients. 
Our  greatest  assistance  is  given  by  simple  physical  and  mental 
means,  and  by  the  careful  employment  of  such  drugs  as  have 
been  adequately  studied,  with  regard  to  the  action  of  which  we 
have  real  information.  Do  not  rashly  use  every  new  product  of 
which  the  peripatetic  siren  sings.  Consider  what  surprising 
reactions  may  occur  in  the  laboratory  from  the  careless  mixing 
of  unknown  substances.  Be  as  considerate  of  your  patient  and 
yourself  as  you  are  of  the  test-tube. 

Familiarize  yourself  with  the  work  of  others  and  never  fail 
to  give  credit  to  the  precursor.  Let  every  student  have  full 
recognition  for  his  work.  Never  hide  the  work  of  others  under 
your  own  name.  Should  your  assistant  make  an  important 
observation,  let  him  publish  it.  Through  your  students  and 
your  disciples  will  come  your  greatest  honor. 

Be  prompt  at  your  appointments;  that  is  always  possible. 
Many  are  always  late  at  a  consultation;  few  miss  a  train. 
There  is  no  excuse  for  tardiness. 

Live  a  simple  and  a  temperate  life,  that  you  may  give  all 
your  powers  to  your  profession.  Medicine  is  a  jealous  mis- 
tress ;  she  will  be  satisfied  with  no  less. 

Save  the  fleeting  minute;  do  not  stop  by  the  way.  Learn 
gracefully  to  dodge  the  bore.  Strike  first  and  quickly,  and 
before  he  has  recovered  from  the  blow,  be  gone;  'tis  the  only 
way 

If  you  can  practice  consistently  all  this,  ....  and  then,  if 
you  can  bring  into  corridor  and  ward  a  light,  springing  step, 
a  kindly  glance,  a  bright  word  to  every  one  you  meet,  arm 
passed  within  arm  or  thrown  over  the  shoulder  of  the  happy 
student  or  colleague;  a  quick,  droll,  epigrammatic  question, 
observation  or  appellation  that  puts  the  patient  at  his  ease  or 
brings  a  pleased  blush  to  the  face  of  the  nurse ;  an  apprehen- 


54  Sir  William  Osleu,  Bart. 

sion  that  grasps  in  a  minute  the  kernel  of  the  situation,  and 
a  memory  teeming  with  instances  and  examples  that  throw 
light  on  the  question ;  an  unusual  power  of  succinct  statement 
and  picturesque  expression,  exercised  quietly,  modestly  and 
wholely  without  sensation;  if  you  can  bring  into  the  lecture 
room  an  air  of  perfect  simplicity  and  directness,  and,  behind 
it  all,  have  an  ever-ready  store  of  the  most  apt  and  sometimes 
surprising  interjections  that  so  light  up  and  emphasize  that 
which  you  are  setting  forth  that  no  one  in  the  room  can  forget 
it ;  if  you  can  enter  the  sick-room  with  a  song  and  an  epigram, 
an  air  of  gaiety,  an  atmosphere  that  lifts  the  invalid  instantly 
out  of  his  ills,  that  produces  in  the  waiting  hypochondriac  so 
pleasing  a  confusion  of  thought  that  the  written  list  of  ques- 
tions and  complaints,  carefully  compiled  and  treasured  for  the 
moment  of  the  visit,  is  almost  invariably  forgotten ;  if  the  joy 
of  your  visit  can  make  half  a  ward  forget  the  symptoms  that  it 
fancied  were  important,  until  you  are  gone;  if  you  can  truly 
love  your  fellow,  and,  having  said  evil  of  no  man,  be  loved  by 
all ;  if  you  can  select  a  wife  with  a  heart  as  big  as  your  own, 
whose  generous  welcome  makes  your  tea-table  a  Mecca ;  .  .  .  . 
if  you  can  do  all  this,  you  may  begin  to  be  to  others  the  teacher 
that  "  the  chief ''  is  to  us ! 

An  eye  whose  magic  wakes  the  hidden  springs 

Of  slumbering  fancy  in  the  weary  mind, 

A  tongue  that  dances  with  the  ready  word 

That  like  an  arrow  seeks  its  chosen  goal, 

And  piercing  all  the  harriers  of  care. 

Opens  the  way  to  warming  rays  of  hope. 

A  presence  like  the  freshening  breeze  that  as 

It  passes,  sweeps  the  poisoned  cloud  aside. 

An  ear  that  'mid  the  discords  of  the  day 

Swings  to  the  basic  harmonies  of  life. 

A  heart  whose  alchemy  transforms  the  dross 

Of  dull  suspicion  to  the  gold  of  love. 

A  spirit  like  the  fragrance  of  some  flower 

That  lingers  round  the  spot  that  this  has  graced, 

To  tell  us  that  although  the  rose  be  plucked 

And  spread  its  perfume  throughout  distant  halls 

The  vestige  of  its  sweetness  quickens  still 

The  conscience  of  the  precinct  where  it  bloomed. 


OSLER  AND  THE  STUDENT 
By  Thomas  R.  Brown" 

In  a  lay  sermon  delivered  before  the  Yale  students  a  few 
years  ago  in  which  Dr.  Osier  offered  them  "  A  way  of  life  " — 
"  a  path  in  which  the  wayfaring  man  cannot  err,  a  life  in  day- 
light compartments,  the  main  business  of  which  is  not  to  see 
dimly  at  a  distance,  but  to  do  what  lies  clearly  at  hand/^  and 
which  had  been  the  starting  point  of  his  life-habit — he  began 
with  two  words  which  show  more  plainly  than  many  pages 
could  his  real  relation  to  the  student — for  these  two  words 
were  "  fellow  students/^  In  these  words  lay  the  real  reason 
for  his  unique  and  lasting  influence  upon  all  who  studied  with 
him,  for  he,  with  his  vast  experience,  his  wonderful  insight, 
his  profound  knowledge,  his  poetic  vision,  his  deep  sympathy, 
was  still  always  at  heart  the  student,  always  studying,  always 
delving  more  deeply  into  the  mysteries  of  health  and  of  disease, 
giving  always,  yet  always  ready  to  receive,  teaching,  yet  ever 
ready  to  learn. 

To  those  privileged  to  be  his  students  in  the  early  days  of 
the  medical  school — a  truly  golden  age  to  each  and  every  one 
of  the  small,  though  ever-growing  group,  he  preached,  as  he 
lived,  a  glorious  philosophy  of  life,  a  joy  in  work,  doing  the 
day's  tasks,  "  living  for  the  day  and  for  the  da/s  work,"  with 
a  wonderful  belief  in  his  f ellowmen,  never  losing  faith  because 
some  had  failed  him,  giving  without  stint  his  best  to  everyone 
with  no  thought  that  some  might  prove  unworthy  of  the  trust. 
He  felt  with  Goethe  that  "the  classical  is  health,  and  the 
romantic  disease,'^  and  he  strove  for  the  one  with  the  Greek 
love  of  perfection,  while  for  the  other  he  had  the  passion  of 
the  truly  adventurous  spirit  sailing  on  uncharted  seas.  To 
us  who  were  his  students  in  the  early  days  of  The  Johns  Hop- 
kins Medical  School,  his  memory  is  so  vivid,  so  fresh,  that  it 
seems  but  as  of  yesterday  when  he  worked  and  played  in  our 

55 


56  Sir  William  Oslee,  Bart. 

midst,  and  we  have  but  to  close  our  eyes  to  see  him  in  fancy, 
almost  as  clearly  as  we  saw  him  in  fact  in  the  late  90's,  the 
great  teacher  and  the  great  student  in  his  manifold  relations 
to  his  students.  Now  we  see  him  riding  to  the  hospital  in  the 
Monument  Street  car,  and  to  the  group  about  him  prophesying 
with  keen  yet  ever  kindly  vision  the  ills — physical,  mental  and 
spiritual  of  the  derelicts  en  route  to  the  dispensary;  here  in 
the  wards  demonstrating  the  complex  psychology  of  Giles  de 
la  Tourette's  disease,  as  exemplified  by  a  poor  bit  of  sodden 
humanity  whose  coprolalia  but  exemplified — in  a  way  a  bit 
embarrassing  at  times  it  is  true — the  symptom-complex  he  was 
discussing,  or  in  an  alcove  off  the  ward  playing  with  little 
Theophilia  as  she  was  emerging  from  the  night  of  cretinism 
into  the  day  of  normal  happy  childhood  under  his  skillful 
guidance;  now  in  the  class-room  of  the  dispensary — for  he 
loved  the  polyclinic,  and  believed  in  its  wonderful  potentiality 
as  a  teaching  factor — with  one  deft  touch  solving  a  case  of 
great  complexity,  or  bringing  from  his  vast  storehouse  of 
knowledge  the  one  last  link  needed  in  a  disease-picture 
hitherto  poorly  understood,  listening,  suggesting,  directing, 
teaching,  guiding  both  student  and  patient,  and  all  the  while 
filling  countless  scraps  of  paper  with  the  names  of  one  of  the 
three  great  teachers  of  his  youth ;  now  in  the  clinical  laboratory 
studying  a  blood  specimen,  and  suggesting  to  the  student  some 
line  of  original  investigation  which  might,  perhaps,  light  into 
flame  the  dormant  investigator  and  research  worker;  now  in, 
the  autopsy  room  studying  in  death  the  puzzles  that  he  had 
helped  to  unravel  during  life ;  now  walking  through  the  wards 
and  corridors  of  the  hospital  with  a  smile  or  an  epigram  for 
every  doctor  and  nurse  who  passed,  a  kindly  word,  and  his 
ever-stimulating  psychotherapy — encouragement,  optimism, 
hope — to  every  patient  he  saw ;  in  his  myriad  activities  always 
making  each  student  feel  that  he  also  was  but  a  student  of 
health  and  of  disease,  of  men  and  of  morals,  and  yet  such  a 
student  as  to  fire  our  minds,  our  souls  and  our  bodies  to  re- 
newed efforts  so  that  we  might,  in  some  measure  at  least,  prove 
worthy  of  this  fraternity.    To  us  who  were  privileged  to  be  his 


OSLER   AND   THE    STUDENT  57 

students — his  fellow  students  in  those  days,  he  was — and  still 
is — always  our  inspiration  and  always  our  model.  In  him  the 
fire  burned  so  brightly  that  no  dross  nor  tinsel  could  survive 
its  pure  flame,  and  he  was  ever  "  our  cloud  by  day,  our  pillar 
of  fire  by  night."  With  Bossuet  he  taught  that  "  le  bon  sens 
est  le  genie  de  Fhumanite,"  and  he  gave  to  us  "  a  golden  age 
which  never  rusts,  a  spring  which  never  fades,  eternal  youth.''* 
Always  true  to  himself  and  to  others,  he  made  us  think  daily 
of  words  of  his  beloved  Plato  "  Whence  has  the  progress  of 
cities  and  nations  arisen  if  not  from  remarkable  individuals 
coming  into  the  world  we  know  not  how  and  from  causes  over 
which  we  have  no  control  ?  " 

Is  not  the  greatest  tragedy  of  growing  older  the  loss  of  our 
illusions — the  discovery  sooner  or  later  that  so  many  of  the 
gods  of  our  youth,  Jove-like  Olympians  of  those  days  when 
our  world  was  young  and  pregnant  with  possibilities,  have, 
after  all,  but  feet  of  clay  ?  But  with  ^^  the  chief  "  this  could 
never  be.  The  more  we  learned,  the  more  wonderful  his  bound- 
less knowledge  seemed ;  the  wider  our  vision,  the  more  limitless 
his  appeared. 

Everyone  who  has  ever  been  his  student  is,  as  it  were,  still 
studying  with  him,  or  peripatetically  following  his  footstepsi 
as  he  journeys  through  life,  always  teaching  some  new  lesson 
of  medicine  or  of  living.  Every  honor  that  has  befallen  him 
has  enriched  us  and  made  us  prouder  of  our  brotherhood; 
every  step  upward  or  onward  of  his  has  made  our  paths  easier 
and  the  heights  seem  not  so  far  away.  We  have  rejoiced  in  his 
happiness  and  in  his  honors,  and  perhaps  he  has  been  helped 
in  his  sorrows  by  the  knowledge  that  they  are  ours  as  well,  for 
he  has  shown  us  how  work  could  be  made  play,  and  how  the 
real  could  be  made  ideal.  Because  of  him  our  lives  have  been 
better,  our  successes  more  real,  our  failures  less  hard  to  bear, 
for  through  the  tangled  skein  that  spells  life  each  of  us  knows 
that  in  him  he  has,  and  will  always  have,  a  teacher,  a  friend, 
and  a  true  fellow  student  to  the  end  of  the  chapter. 


OSLEE  AND  PATIENT 
By  Thomas  McCrab 

In  all  the  relations  of  physician  to  patients  there  are  two 
sides — the  strictly  medical  and  the  personal.  Some  have  a 
blind  spot  for  the  latter,  but  taking  the  profession  as  a  whole 
these  are  in  the  minority.  ISTo  one  could  work  in  close  associa- 
tion with  Sir  William  Osier  without  realizing  that  both  sides 
were  well  developed  in  him.  There  was  always  the  desire  to  do 
the  best  for  the  patient  in  a  medical  way,  but  the  personal 
aspect  was  never  forgotten.  Patients  were  patients  and  not 
cases.  Interest  in  the  personal  side  was  much  in  evidence  and 
it  was  the  exception  for  his  patients  to  fail  in  appreciating  this. 
There  was  always  a  great  charity  for  the  weakness  of  human 
nature  and  there  were  neither  unkind  nor  hasty  judgments. 
We  know  how  often  in  his  addresses  he  has  emphasized  the 
importance  of  this  quality. 

To  the  writer  was  given  the  opportunity  of  knowing  the 
relation  of  Sir  William  Osier  to  the  patient  both  by  personal 
experience  and  by  the  observation  of  others.  The  former 
came  by  my  having  an  attack  of  typhoid  fever  while  a  house 
officer  in  The  Johns  Hopkins  Hospital.  After  the  passage 
of  years  it  is  difficult  to  estimate  in  detail  one's  feelings  to- 
wards his  physician,  but  the  main  impression  left  on  my  mind, 
after  a  long  interval  is  that  of  absolute  confidence.  His  visits 
were  usually  short,  but  when  he  had  gone  there  was  a  feeling 
that  everything  was  all  right.  The  visit  was  nearly  always 
marked  by  some  cheering  saying  or  amusing  quip. 

One  incident  comes  to  memory  with  regard  to  the  impres- 
sion made  by  him  on  a  patient  many  years  ago ;  it  is  also  an 
example  of  curious  coincidence.  Back  in  the  eighties  one  of 
my  father's  friends  was  stricken  with  a  malady  of  which  I 
heard  some  of  the  details  discussed  without  realizing  that  they 

59 


60  Sir  William  Osler,  Bart. 

were  to  be  remembered.  The  patient  had  Addison's  disease 
with  an  unusual  degree  of  pigmentation  which  attracted  great 
attention  and  was  naturally  commented  on  by  his  friends.  I 
remembered  hearing  that  he  had  gone  to  the  United  States  to 
consult  a  physician  and  had  come  back  realizing  that  he  could 
not  recover.  These  matters  had  apparently  been  completely 
forgotten,  but  were  recalled  when  25  years  later  the  friend  who 
accompanied  the  patient  on  the  Journey  said  to  me:  "I 
wonder  if  you  could  help  me  to  identify  the  physician  whom 
Mr.  X  consulted  in  Philadelphia.  His  name  made  little  im- 
pression on  me  at  the  time.'^  This  seemed  rather  a  difficult 
undertaking,  but  I  asked  what  he  remembered  of  the  visit. 
He  gave  the  following  details :  "  The  examination  was  very 
thorough ;  he  stripped  Mr.  X  and  went  over  him  from  head  to 
foot.  He  said  very  little.  (At  this  point  the  thought  of  Sir 
William  came  to  my  mind.)  When  Mr.  X  asked  him  as  to  the 
outlook,  he  said,  ^  Do  you  think  you  have  enough  of  the  grace 
of  Grod  to  make  a  clergyman,'  or  something  like  that.  At  any 
rate  Mr.  X  understood  the  meaning  which  was  intended  and 
commented  with  approval  on  the  way  in  which  it  was  con- 
veyed." Afterwards  I  asked  Sir  William  if  he  was  the  physi- 
cian, and  found  that  he  was  and  that  he  remembered  the 
patient  very  well. 

This  brings  up  another  of  his  characteristics  with  regard 
to  patients — the  marvellous  memory  which  he  has  of  the  details 
regarding  many  of  them.  On  one  occasion  a  physician  brought 
a  patient  to  consult  him.  The  physician  began  to  give  the 
history  when  Sir  William  said :  '^  I  saw  Mr.  —  before  with  so 
and  so  " — mentioning  the  diagnosis.  Both  the  physician  and 
the  patient  deified  this  until  Sir  William  showed  them  the 
notes  of  the  previous  visit.  It  seems  almost  impossible  to 
imagine  that  both  should  have  forgotten  the  consultation,  but 
such  was  the  case.  On  many  occasions  patients  came  back  to 
the  clinic  after  an  interval  of  years  and  Sir  William  could  give 
the  details  of  the  history  at  once. 

In  one  of  his  essays,  which  gives  the  title  to  a  book,  "  Aequa- 
nimitas,"  he  dwells  on  the  importance  of  not  permitting  one's 


OsLBR  AND  Patient  61 

poise  to  be  disturbed  or  allowing  the  expression  to  show  what 
would  be  better  concealed.  He  practised  this  in  his  daily 
work  and  many  who  came  in  contact  with  him  never  realized 
how  much  anxiety  he  often  felt,  but  rarely  displayed  over 
patients.  This  was  particularly  true  if  it  was  a  case  in  which 
a  diagnosis  had  not  been  made  and  in  which,  therefore,  the 
best  treatment  was  a  question  of  doubt.  One  such  instance 
comes  to  mind  of  a  young  man  with  typhoid  fever  and  severe 
hemorrhages.  In  this  case,  of  course,  we  were  suspicious  of 
perforation.  Sir  William  made  a  special  trip  to  the  hospital 
at  my  request  to  try  and  settle  this  point.  The  decision  was 
that  there  was  no  positive  evidence  of  perforation  and  explora- 
tion was  delayed,  but  the  signs  of  general  peritonitis  next  day 
showed  our  error.  I  remember  well  his  words  on  the  fallibility 
of  human  judgment  and  of  the  sorrow  that  one  felt  when  he 
had  judged  wrongly. 

His  influence  over  patients  was  marked  and  especially  over 
those  unfortunates  whose  nervous  systems  had  suffered.  As  a 
general  rule  he  did  not  spend  a  great  deal  of  time  over  them  in 
the  hospital.  However,  the  results  came;  in  many  cases  no 
doubt,  largely  by  faith  in  him.  It  has  been  said  by  some  that 
Sir  William  was  not  particularly  interested  in  psychotherapy, 
but  one  might  say  that  he  did  not  need  to  be — he  practised  it, 
not- always  consciously,  perhaps,  but  always  effectively.  He 
had  extraordinary  patience  with  querulous  patients  and  it  was 
very  rarely  that  he  ever  became  irritated  with  them.  With  the 
patient  who  was  ready  to  fight  and  be  disagreeable  he  never 
argued :  "  Glad  to  see  you  come  and  glad  to  see  you  go  ^^  was 
a  favorite  answer. 

Many  interviews  with  patients  come  to  memory.  In  one  the 
center  of  the  stage  was  occupied  by  a  nervous  woman,  to  whom 
something  had  been  said  in  a  very  kindly  way  of  the  need  of 
self-control.  With  the  tears  flowing  freely  and  a  handkerchief 
in  active  use  she  said:  "Oh,  Dr.  Osier  you  misjudge  me 
cruelly."  He,  standing  at  the  foot  of  her  bed,  replied  with  a 
serious  tone  to  his  voice  and  a  twinkle  in  his  eye :  "  Madam, 
I  learned  early  in  life  never  to  judge  any  woman  and  that  rule 


62  Sir  William  Osler,  Bart. 

I  have  strictly  kept.  Therefore,  I  cannot  have  misjudged  you. 
Good  morning  '^ — and  he  was  away  before  she  could  frame  a 
reply.    Later  in  the  day  the  brunt  of  his  hasty  exit  fell  on  me. 

In  a  large  private  ward  service  it  was  not  possible  for  him 
to  spend  a  long  time  with  each  patient.  To  his  house  officers 
it  was  always  a  source  of  interest  and  a  good  lesson  to  observe 
how  he  could  get  into  and  out  of  a  patient's  room  without 
giving  a  chance  for  the  flood-gates  of  talk  to  open.  Many 
patients  would  lament  that  they  had  not  been  able  to  tell  him 
this  or  that.  But  with  this  he  had  a  remarkable  ability  in 
discerning  when  the  patient  needed  a  special  interview  and  he 
was  always  ready  to  give  it. 

There  was  one  subject  on  which  he  would  never  listen  to  a 
patient,  and  that  was  when  something  was  said  which  reflected 
on  another  physician.  When  the  patient  began  any  such  state- 
ments he  showed  his  displeasure  at  once  and  if  this  was  not 
enough  a  very  sharp  rebuke  followed.  In  fact  this  was  about 
the  only  thing  which  made  him  lose  patience  and  was  the  rare 
occasion  of  his  showing  sternness.  The  talkative  patient  was 
a  trial  to  him — and  of  whom  is  this  not  true?  He  used  to 
have  a  very  characteristic  look  when  he  escaped  and  I  can 
remember  his  delight,  after  a  particularly  trying  interview  of 
the  kind,  when  I  quoted  to  him  from  '^  Kim '' :  "  The  husbands 
of  the  talkative  will  have  a  great  reward  hereafter.'^  However, 
he  was  rarely  caught  twice  by  the  same  person. 

Of  one  class  of  his  patients  a  word  may  be  said — the  doctors. 
He  was  consulted  by  many  of  the  profession  and  especially  in 
the  latter  years  in  Baltimore.  This  had  grown  to  be  a  heavy 
burden,  but  one  which  he  carried  willingly.  He  never  spared 
himself  or  thought  of  his  own  convenience  when  something 
was  to  be  done  for  a  physician  or  a  member  of  a  physician^s 
family. 

Of  the  attitude  of  patients  towards  Sir  William  much  might 
be  said.  Perhaps  the  most  striking  characteristic  was  absolute 
confidence.  There  was  the  cert-ainty  that  there  would  be  no 
failure  from  lack  of  skill  or  interest  on  his  part.  His  cheer- 
fulness had  much  to  do  with  this  and  the  ability  to  give  the 


OsLEK  AND  Patient  63 

desire  to  fight  to  those  who  had  lost  courage  and  hope.  He 
was  always  careful  in  giving  an  opinion  to  put  matters  simply, 
so  that  the  chance  of  misunderstanding  would  be  as  slight  as 
possible.  In  the  consideration  of  what  a  patient  should  do  he 
always  had  in  mind  what  he  could  do.  It  was  a  good  lesson 
to  observe  the  care  which  he  took  to  avoid  saying  anything  in 
the  hearing  of  a  patient  which  might  cause  disturbance  or 
increase  anxiety.  This  was  especially  marked  when  the  out- 
look was  being  discussed  and  seemed  unfavorable.  He  never 
forgot  to  be  sure  that  the  patient  was  not  within  hearing.  In 
all  the  giving  of  advice  he  was  sparing  of  words  and  might  be 
described  as  one  of  those  "  who  have  not  the  infirmity,  but  the 
virtue  of  taciturnity,  and  speak  not  out  of  the  abundance,  but 
the  well-weighed  thoughts  of  their  hearts." 


OSLER  AND  THE  TUBEECULOSIS  WORK  OF 
THE  HOSPITAL 

By  Louis  Hamman 

Dt.  Osler^s  interests  were  so  universal  that  I  fear  I  run  grave 
risk  of  contradiction  in  saying  that  he  showed  a  particular 
interest  in  tuberculosis.  I  came  in  contact  very  intimately 
with  his  enthusiasm  for  tuberculosis  study  and  perhaps  for  this 
reason  I  exaggerate  the  position  it  held  for  him.  Certainly 
he  never  tired  of  reiterating  to  students  the  importance  of  a 
thorough  knowledge  of  the  two  great  infectious  diseases,  tuber- 
culosis and  syphilis.  From  the  beginning  of  his  career  as 
physician-in-chief  to  this  hospital  he  studied  the  tuberculous 
patients  with  minute  care.  The  first  patient  admitted  to  his 
medical  service  on  May  16,  1889,  was  suffering  from  tubercu- 
lous peritonitis  and  one  of  the  first  clinical  papers  he  published 
was  upon  this  aspect  of  tuberculous  disease.  In  1903  I  under- 
took at  his  request  a  study  of  all  the  cases  of  serous  membrane 
tuberculosis  that  had  been  in  the  hospital  up  to  that  date  and  I 
noted  that  many  of  the  histories  have  copious  notes  dictated 
by  him. 

That  this  interest  in  tuberculosis  extended  beyond  the 
details  of  clinical  observation  is  shown  by  the  establishment  in 
1898  of  a  special  fund  for  the  study  of  tuberculosis,  the 
initiative  for  its  inauguration  and  much  of  the  money  coming 
from  Dr.  Osier  himself.  Dr.  Charles  D.  Parfitt  was  appointed 
to  conduct  the  work  and  a  laboratory  was  equipped  to  afford 
him  suitable  opportunity  for  investigation.  Unfortunately 
after  an  active  year,  which  gave  promise  of  substantial  con- 
tributions to  the  study  of  tuberculosis.  Dr.  Parfitt  was  taken 
ill  and  the  work  was  abandoned  to  be  resumed  some  years  later 
in  the  laboratory  of  the  Phipps  dispensary. 

A  further  evidence  of  Dr.  Osier's  unfailing  interest  in  tuber- 
culosis, and  his  zeal  for  the  dissemination  of  tuberculosis 

5  65 


66  Sir  William  Oslee,  Bart. 

knowledge  amongst  the  students,  is  the  foundation  of  the 
Laennec  Society  in  1900.  This  was  the  first  society  in  this 
country  and,  as  far  as  I  know,  the  first  in  the  world  to  devote 
itself  to  the  study  of  tuberculosis.  I  remember  clearly  the  first 
meeting  of  the  society  held  in  the  fall  of  1900  in  the  basement 
under  Ward  G.  Dir.  Osier  presided,  outlining  the  aims  of  the 
society  and  explaining  the  appropriateness  of  its  name;  a  re- 
view of  Laennec's  life  and  work  followed.  Since  this  date  the 
society  has  continued  to  hold  regular  meetings  and  it  has 
proved  itself  an  important  and  stimulating  center  of  tuber- 
culosis interest  in  the  hospital.  Unfortunately,  there  are  no 
records  of  the  early  meetings  of  the  society,  but  I  remember 
Dr.  Osler^s  unfailing  attendance  at  all  the  meetings  and  his 
brilliant  and  stimulating  discussions. 

Shortly  after  the  establishment  of  the  Laennec  -Society 
Dr.  Osier  with  his  peculiar  prescience  of  coming  events  in- 
augurated the  home  visiting  of  tuberculous  patients  registering 
in  the  dispensary.  At  first  this  work  was  undertaken  by 
medical  students,  Blanche  N".  Epler,  Adelaide  Dutcher  and 
Elizabeth  H.  Blauvelt  successively  giving  it  their  service.  The 
study  of  Miss  Dutcher  reported  before  the  Laennec  Society 
and  published  in  the  Philadelphia  Medical  Journal,  December 
1,  1900,  is,  I  believe  the  first  contribution  in  this  country  to 
lay  the  proper  emphasis  upon  the  importance  of  the  home  in 
the  spread  of  tuberculosis.  From  this  modest  beginning  grew 
the  subsequent  study  and  care  and  supervision  of  tuberculous 
patients  in  the  dispensary.  Dr.  Osier  soon  enlisted  the  interest 
of  Mr.  Victor  Bloede  in  the  work  and  through  his  generous 
support  a  nurse  was  employed  to  visit  and  instruct  patients 
in  their  homes.  At  the  same  time  under  his  guidance  the  first 
steps  were  taken  towards  establishing  a  special  clinic  for  the 
tuberculous.  Although  no  separate  rooms  were  available  for 
this  purpose,  all  tuberculous  patients  were  put  under  the  care 
of  Dr.  Herman  Bruelle  for  detailed  study  and  advice. 

It  would  give  a  very  incomplete  impression  of  Dr.  Osier's 
tuberculosis  interests  to  omit  reference  to  his  activities  outside 
of  the  hospital.    He  was  always  deeply  concerned  about  the 


Tuberculosis  Work  of  the  Hospital  67 

social  applications  of  medical  knowledge  and  he  played  a 
prominent  part  in  furthering  and  directing  the  awakening 
interest  in  the  control  of  tuberculosis  as  a  disease  of  the  masses. 
For  instance,  he  took  a  very  active  interest  in  the  Tuberculosis 
Exposition  held  in  January,  1904,  under  the  auspices  of  the 
State  Board  of  Health,  the  first  exposition  of  the  kind  held  in 
this  country.  Under  his  influence  a  remarkable  collection  of 
books  on  tuberculosis  were  displayed,  illustrating  the  develop- 
ment of  our  knowledge  of  the  disease  from  Hippocrates  to 
modern  times.  Before  the  collection  was  dispersed  Dr.  Osier 
reviewed  it  with  the  medical  students,  illuminating  each  epoch 
with  his  surprising  knowledge  of  the  historical  aspects  of  the 
subject. 

In  1903  Mr.  Henry  Phipps  learned  of  the  work  Dr.  Osier 
was  trying  to  do  with  such  modest  equipment  and  generously 
sent  $10,000  to  support  his  endeavors.  The  check  came  quite 
unexpectedly  and  was  the  means  for  Dr.  Osier  to  plan  at  once 
to  materialize  one  of  his  dreams.  With  great  enthusiasm  he 
began  to  develop  a  special  department  for  the  study  of  tuber- 
culosis and  the  care  of  tuberculous  patients.  Mr.  Phipps' 
additional  gift  of  over  $20,000  made  it  possible  to  remodel 
the  old  stable  standing  between  the  dispensary  and  pathological 
department  buildings  into  a  two-story  structure  with  four 
rooms  on  each  floor.  The  building  was  formally  opened  at  a 
special  meeting  of  the  Laennec  Society  on  February  21,  1905, 
and  the  first  patients  were  received  on  the  first  of  March  of  the 
same  year. 

Dr.  Osier  left  the  hospital  the  year  the  tuberculosis  dis- 
pensary was  opened,  but  his  interest  in  the  department  never 
ceased.  Messages  of  encouragement  and  appreciation  came  at 
irregular  intervals.  Whenever  an  article  appeared  by  a  mem- 
ber of  the  staff,  usually  the  first  and  always  the  dearest  recog- 
nition was  a  postal  or  a  brief  note  dashed  off  in  his  character- 
istic way.  As  the  dispensary  gradually  grew  into  a  recognized 
place  in  the  medical  clinic,  at  every  turn  of  fortune  there  came 
his  cheering  congratulation.  It  is  impossible  for  me  to  look 
back  upon  those  years  without  the  deepest  emotion.    I  do  not 


68  Sir  William  Osler,  Bart. 

know  if  Dr.  Osier  ever  appreciated  what  these  crisp,  kindly 
messages  flashed  from  abroad  really  meant  for  us,  nor  am  I 
able  adequately  to  express  all  we  felt.  Certainly  this  much  is 
true,  they  were  always  the  brightest  ray  of  encouragement  to 
our  work,  the  most  comforting  reward  that  made  us  forget  the 
long,  dreary  hours  of  labor  and  the  discouragement  and  doubt 
that  often  assailed  us. 

Since  the  first  few  years  the  tuberculosis  dispensary  has 
grown  steadily  in  importance.  Further  gifts  from  Mr.  Phipps 
allowed  the  hospital  to  add  to  the  building  in  1908,  doubling 
its  capacity.  Eecently  the  generosity  of  Mr.  Kenneth  Dows 
has  further  improved  the  building  and  has  put  the  research 
department  of  the  dispensary  upon  a  sound  footing.  The 
tuberculosis  clinic  is  a  very  different  department  now  from  the 
modest  dispensary  arrangements  of  a  physician  without  a  room 
to  work  in  and  with  no  other  equipment  but  his  stethoscope. 
But  this  is  the  fruit  that  has  grown  from  that  tiny  seed  of 
interest  and  enthusiasm  planted  by  Dr.  Osier  many  years  ago. 


INFLUENCE  ON  THE  RELATION  OF  MEDICINE  IN 
CANADA  AND  THE  UNITED  STATES 

By  Thomas  B.  Futcher 

Sir  William  Osier  has  done  more  than  any  other  member  of 
our  profession  to  bring  about  cordial  and  intimate  relation- 
ships between  its  members  in  the  United  States  and  Canada. 
A  Canadian  by  birth,  a  graduate  of  McGill  University, 
Canada's  most  distinguished  medical  representative,  and  a 
man  with  a  most  magnetic  personality  and  great  breadth  of 
sympathies  and  interests,  it  is  only  natural  that  he  should 
have  exerted  a  most  potent  influence  in  encouraging  close  asso- 
ciations between  the  members  of  the  profession  in  the  two 
countries.  Particularly  was  this  the  case  after  his  call  to 
Philadelphia  in  1884,  and  to  Baltimore  in  1889.  While  this 
bond  has  naturally  been  more  intimate  between  internists,  his 
influence  indirectly  brought  about  a  closer  contact  between  the 
members  of  the  other  specialties. 

Although  Osier  was  graduated  in  medicine  from  McGill 
University,  he  was  born  at  Tecumseh,  Ontario,  on  July  12, 
1849,  and  was  educated  at  Trinity  College,  Toronto.  Various 
members  of  his  family,  leaders  in  their  respective  professions, 
have  resided  in  the  latter  city.  As  his  reputation  grew,  it  was 
only  natural  that  his  influence  on  the  profession  in  the  two 
older  provinces  of  Canada  should  have  been  very  great. 

After  his  graduation  from  McGill  in  1872,  he  spent  the  next 
two  years  in  research  work  abroad,  at  University  College, 
London,  and  at  Berlin  and  Vienna,  where  he  formed  associa- 
tions with  such  men  as  E.  A.  Schafer,  Virchow,  Nothnagel 
and  others.  While  abroad,  he  published  in  1873  his  researches 
on  the  blood  platelets  in  which  he  established  their  corpuscular 
character.  Upon  his  return  to  Montreal  in  1874,  he  was 
appointed  professor  of  the  institutes  of  medicine,  at  McGill 

69 


70  Sir  William  Osler,  Bart. 

University,  a  position  he  filled  until  1884.  During  this  period, 
he  was  brought  into  intimate  association  with  his  old  teacher, 
Eobert  Palmer  Howard,  who  was  professor  of  medicine  and 
dean  of  the  medical  faculty,  and  with  those  able  clinicians, 
Eoss  and  MacDonnell.  His  natural  bent  for  research  and 
investigation,  had  been  further  stimulated  by  his  experiences 
abroad.  A  full  appreciation  of  the  importance  of  the  micro- 
scope in  medical  research  led,  upon  his  return,  to  its  more 
extensive  adoption  in  the  laboratories  of  McGill.  While  there. 
Osier  laid  the  foundation  of  his  keenness  as  a  clinician^  through 
his  recognizing  the  great  importance  of  following  the  fatal 
cases  to  the  autopsy  room,  performing  many  of  the  necropsies 
himself.  These  investigations  resulted  in  the  publication  of 
numerous  important  contributions  to  medical  literature. 
Among  these  may  be  mentioned  his  paper  in  which  mycotic 
aneurisms  in  association  with  ulcerative  endocarditis  were 
described  for  the  first  time,  and  his  account  of  the  ball-valve 
thrombus  at  the  mitral  orifice,  which  also  was  the  first  recorded 
case. 

He  was  very  much  interested  in  comparative  pathology,  and 
performed  many  autopsies  on  lower  animals  with  that  keen 
veterinarian,  Clements,  who  later  went  to  Baltimore,  where  he 
died  an  untimely  death  from  myocardial  disease. 

Many  of  Osier's  students  of  this  period  are  scattered 
throughout  Canada  and  the  United  States,  and  they  look  back 
with  pleasure  and  profit  to  the  training  and  stimulus  they 
received  under  him  at  McGill.  One  of  the  powerful  influences 
he  possesses  was  manifested,  even  in  these  early  years,  through 
his  readiness  to  report  interesting  observations  before  local 
medical  societies  and  provincial  medical  associations,  and  to 
encourage  others  to  do  likewise. 

Osier's  contributions  to  medical  literature  while  at  McGill, 
and  his  papers  read  before  medical  societies  in  the  United 
States,  naturally  attracted  a  great  deal  of  attention,  and,  when 
in  1884  the  University  of  Pennsylvania  was  seeking  the  best 
trained  man  to  fill  the  chair  of  professor  of  clinical  medicine. 
Osier  was  its  choice.    While  in  Philadelphia  he  was  brought 


Medicine  in  Canada  and  the  United  States      71 

into  close  association  with  such  men  as  Weir  Mitchell,  William 
Pepper,  Tyson,  Musser,  Keen,  Wilson  and  others.  His  influ- 
ence on  medicine  in  the  United  States  was  very  marked  even 
during  this  Philadelphia  sojourn  from  1884  to  1889.  He  was 
one  of  the  original  members  of  the  Association  of  American 
Physicians,  which  was  organized  in  1886  with  Francis  A. 
Delafield  as  its  first  president.  He  always  took  an  active 
interest  in  the  annual  meetings  of  the  association,  contributing 
numerous  original  papers  and  entering  into  the  discussions. 
He  was  himself  its  president  in  1895. 

While  at  the  University  of  Pennsylvania,  Osler^s  contribu- 
tions to  medical  literature  were  numerous  and  important. 
Much  of  his  material  for  his  monograph  on  the  "  Cerebral 
Palsies  of  Children,^'  published  in  1889,  was  gathered  during 
this  period.  His  experience  at  Blockley,  that  wonderful  store- 
house of  clinical  and  pathological  material,  provided  him  with 
a  mass  of  data  later  freely  utilized  in  the  preparation  of  his 
text-book. 

In  1889,  as  the  construction  of  The  Johns  Hopkins  Hospital 
was  nearing  completion,  the  trustees  of  the  university  and 
hospital,  seeking  the  best  man  to  fill  the  chair  of  professor  of 
medicine  in  the  university,  and  the  position  as  physician-in- 
chief  to  the  hospital,  at  once  thought  of  Osier,  who  was  then 
considered  the  most  brilliant  clinician  available.  The  offer 
was  tendered  and  accepted,  and  he  was  on  duty  when  the  first 
patient  was  admitted  to  the  hospital  on  May  10,  1889. 

It  was  during  his  period  of  residence  in  Baltimore  from 
1889  to  1905  that  Osier's  influence  on  medicine  in  the  United 
States  and  Canada  was  chiefly  exerted.  In  making  appoint- 
ments to  his  hospital  staff,  graduates  of  medical  schools  in  both 
the  United  States  and  Canada  shared  the  privilege  of  working 
under  him.  Owing  to  his  close  affihations  with  teachers  in  the 
Canadian  medical  schools,  it  was  only  natural  that  these  men 
should  be  appealed  to  from  time  to  time  to  supply  assistants 
for  its  interne  staff.  His  first  resident  physician  was  Lafleur, 
of  McGill,  who  during  his  tenure  collaborated  with  Council- 
man in  the  publication  of  their  important  monograph  on 


73  Sir  William  Osler,  Baet. 

amoebic  dysentery.  Lalleur,  as  have  other  assistants,  returned 
to  Canada  and  carried  with  him  to  McGill  and  the  Montreal 
General  Hospital  the  stimulus  and  methods  acquired  while 
under  Osier.  Hewetson,  also  of  McGill,  soon  followed  Lafleur 
as  an  assistant.  The  unfortunate  development  of  tuberculosis 
prevented  him  from  pursuing  what  promised  to  be  a  brilliant 
career.  Thayer,  of  Harvard,  who  now  holds  the  chair  in 
medicine  on  the  whole-time  basis,  succeeded  Lafleur  as  resi- 
dent physician  and  served  until  1901. 

J.  E.  Graham,  who  was  for  many  years  professor  of  medicine 
at  Toronto  University,  an  excellent  clinician  and  a  man  much 
beloved  by  his  students,  was  a  close  personal  friend  of  Osier, 
Through  him  several  Toronto  University  graduates  became 
assistants  of  the  latter.  Among  these  may  be  mentioned. 
Barker,  Parsons,  Thomas  McCrae,  the  late  John  McCrae — 
the  immortal  composer  of  ^^  In  Flanders^  Fields,"  Gwyn,  and 
the  writer.  It  may  be  of  interest  to  note  that  all  these,  with 
one  exception,  were  previously  resident  physicians  during  the 
summer  months  at  the  Eobert  Garrett  Hospital  for  Children 
at  Mt.  Airy,  Md.,  which  was  under  the  direction  of  Dr.  Walter^ 
B.  Piatt.  Barker,  later  succeeded  Osier,  as  professor  of  medi- 
cine. The  writer,  and  Thomas  McCrae,  in  turn  succeeded 
Thayer  as  resident  physicians.  W.  G.  MacCallum,  now  the 
professor  of  pathology  at  Johns  Hopkins,  although  a  medical 
graduate  of  this  university,  but  a  graduate  in  the  academic 
department  of  the  University  of  Toronto,  was,  after  gradua- 
tion, an  assistant  on  Osier's  staff.  Mention  is  made  of  these 
various  Canadians  to  point  out  how  Osier  acted  as  a  magnet  to 
draw  them  from  across  the  border  to  Baltimore,  and  to  empha- 
size the  fact  that  they  have,  through  their  "  chief,''  indirectly 
constituted  an  important  hnk  helping  to  keep  up  intimate 
associations  between  the  profession  on  both  sides  of  the  line. 

Following  Thomas  McCrae,  the  resident  physicians,  with  the 
exception  of  B.  A.  Cohoe,  a  medical  graduate  of  Toronto 
University,  who  served  from  June  to  September,  1908,  have 
all  been  graduates  of  The  Johns  Hopkins  Medical  School. 
They  have  been  in  succession,  Eufus  I.  Cole,  Charles  P.  Emer- 


Medicine  in  Canada  and  the  United  States      73 

son,  Thomas  E.  Boggs,  Frank  J.  Sladen,  Paul  W.  Clough  and 
the  present  occupant,  Arthur  L.  Bloomfield.  Cole  was  the  only 
one  of  these  who  served  as  resident  physician  during  Osler^s 
occupancy  of  the  chair  of  medicine,  although  Emerson  and 
Boggs  were  assistant  resident  physicians  under  him  before  he 
left  for  Oxford,  in  1905.  Osier's  ideals  and  influence  have 
been  disseminated  by  this  group  of  resident  physicians  in  the 
various  fields  in  which  their  activities  have  been  cast. 

The  first  edition  of  Osier's  "  Principles  and  Practice  of 
Medicine  "  appeared  in  1892.  This,  and  the  subsequent  seven 
editions,  have  been  the  standard  text-book  in  medicine  used 
by  students  and  practitioners  in  both  the  United  States  and 
Canada.  The  influence  of  this  work,  with  the  fascinating  and 
practical  way  in  which  the  various  diseases  were  treated,  has 
been  very  great  on  the  professions  of  both  countries.  The  same 
can  be  said  for  the  two  editions  of  "Modern  Medicine,"  of 
which  he  was  chief  editor,  Thomas  McCrae  being  associated 
with  him. 

Throughout  Osier's  professorship  at  Johns  Hopkins,  courses 
to  post-graduates  were  given  yearly.  The  medical  school  was 
not  opened  until  1893,  and  uncler-graduate  instruction  in 
medicine  consequently  did  not  begin  until  1895,  so  that,  up  to 
that  year,  post-graduate  instruction  was  the  only  teaching 
conducted  in  the  medical  wards.  Osier's  ward  clinics  and 
clinical  lectures  were  attended  by  physicians  from  all  parts  of 
the  United  States  and  Canada.  Members  of  the  profession 
rubbed  shoulders,  gained  invaluable  clinical  experience,  and 
formed  professional  ties  and  friendships  which  have  continued 
ever  since. 

Although  domiciled  in  the  United  States,  the  Canadian 
profession  always  felt  that  it  had  a  personal  claim  on  Osier. 
His  trips  to  Canada  to  see  his  family  in  Toronto,  to  consult 
with  physicians,  to  read  papers  before  societies  in  various  parts 
of  the  Dominion,  and  often  to  spend  his  vacation  on  the  lower 
St.  Lawrence,  enabled  him  to  keep  in  close  touch  with  the 
profession  of  his  native  land  and  to  exert  a  strong  influence  on 
its  members  north  of  the  border. 


74  Sir  William  Oslek,  Bakt. 

Almost  as  important  a  sphere  of  influence  as  The  Johns 
Hopkins  Hospital  was  Osler^s  home  at  1  West  Franklin  Street, 
where  physicians  from  both  sides  of  the  line  were  always  wel- 
come, and  where  they  were  ever  made  to  feel  at  home  by  the 
"  chief  "  and  his  gracious  wife,  now  Lady  Osier. 

In  1905  Osier  was  called  to  Oxford  to  occupy  the  chair  of 
Eegius  Professor  of  Medicine  in  that  university.  His  interest 
in  the  medical  profession  of  both  countries  has  not  a  whit 
abated.  The  home  of  Sir  William  and  Lady  Osier,  at  13  l^or- 
ham  Gardens,  has  been  almost  a  daily  rendezvous  for  the 
khaki-clad  medical  officers  of  the  American  and  Canadian 
Expeditionary  Forces  during  the  last  two  years  of  the  world's 
war. 


OSLEE  AS  A  CITIZEN  AND  HIS  RELATION  TO  THE 
TUBERCULOSIS  CRUSADE  IN  MARYLAND 

By  Henry  Barton  Jacobs 

Though  Osier  like  Nathan  Smith,  Austin  Flint  and  Marion 
Sims  and  the  philosophers  of  old  is  essentially  a  peripatetic, 
a  medical  nomad,  yet  wherever  his  feet  may  take  him,  there 
he  establishes  and  identifies  himself,  interests  himself  in  local 
conditions  and  undertakes  the  responsibilities  of  citizenship. 

In  the  course  of  his  wanderings  Baltimore  has  had  the 
privilege  and  the  profit  of  halting  his  onward  steps  for  fully 
sixteen  years.  Here  he  came  in  the  vigor  of  his  promising  40 
years,  trained  and  ready,  not  to  say  anxious,  to  jump  into  the 
life  of  his  new  surroundings.  Many  paths  there  are  which  lead 
to  useful  citizenship — Osier  chose  one  peculiarly  his  own,  and 
followed  it  consistently  and  unfailingly,  guided  only  by  the 
unswerving  conviction  that  whatever  he  might  do  to  advance 
and  improve  conditions  in  the  profession  to  which  he  was 
allied,  in  that  way  alone  could  he  be  of  the  greatest  benefit, 
not  only  to  those  immediately  under  his  tutelage  or  care,  but 
to  the  city  and  to  the  nation  at  large.  In  his  final  address  on 
leaving  Baltimore  he  says  "  I  have  lived  my  life  in  my  beloved 

profession I  have  never  departed  from  my  ambition  to 

be  first  of  all  a  servant  to  my  brethren." 

The  advancement  and  improvement  of  medicine  and  ser- 
vice to  his  fellows,  therefore,  is  the  primary  path  of  his  en- 
deavor. The  wayside  results  of  such  a  course  pursued  with 
intensity,  with  kindness,  with  sympathy,  with  laughter  and 
Joke,  with  good  fellowship  and  hospitality,  also  with  hard 
study  and  thought  and  work,  diligently  and  persistently,  year 
by  year,  are  quite  unusual,  and  lead  as  is  only  natural  to 
wide  friendships,  extraordinary  and  general  influence,  both 

with  individuals  and  with  peoples. 

75 


76  Sir  William  Osler,  Baet. 

Scarcely  had  he  arrived  in  Baltimore  in  the  spring  of  1889 
when  he  was  asked  by  the  officers  of  the  State  Medical  Asso- 
ciation, the  old  Medical  and  Chirnrgical  Faculty  of  Mary- 
land, to  deliver  the  oration  at  the  annual  meeting  of  the 
society  to  be  held  in  April  of  that  year.  This  invitation  he 
accepted,  choosing  for  his  topic  "  The  License  to  Practice/^ 
At  this  period  it  should  be  recalled  there  were  in  Baltimore 
no  less  than  four  or  five  medical  schools  with  two-year  courses 
of  study  for  a  degree  to  practice,  and  this  degree  the  only 
license  required.  The  argument  Dr.  Osier  made  in  his  ad- 
dress was  so  cogent,  so  direct,  so  illustrative  of  the  evil  con- 
ditions existing  that  immediate  steps  were  taken  by  the 
leaders  of  the  medical  profession  of  the  city  and  state  to  have 
prepared  a  legislative  Bill  for  the  appointment  of  medical 
examiners  whose  duty  it  should  be  to  examine  candidates,  and 
to  issue  to  the  successful  ones  licenses  to  practice.  This  was 
Dr.  Osier's  first  effort  in  Maryland  toward  the  advancement 
and  improvement  of  medicine,  and  coincidently  his  first  pro- 
nounced effort  in  good  citizenship.  As  a  farther  resultant  the 
Dniversity  of  Maryland  decided  to  lengthen  its  course  of 
medical  study  and  to  raise  its  standard.  Moreover,  the  seed 
was  growing  so  fast  that  in  February,  1890,  a  meeting  of 
representatives  of  all  the  medical  schools  of  Baltimore  de- 
cided to  request  delegates,  from  the  medical  schools  of  the 
country,  to  meet  in  Nashville  with  the  idea  of  raising  the 
standard  of  medical  schools  all  over  the  United  States.  At 
this  conference  an  agreement  was  reached  for  a  three-year 
course  and  other  reforms. 

The  Legislature  of  1890  passed  the  Bill  for  the  appoint- 
ment of  a  board  of  medical  examiners,  a  bill  which  looked 
to  the  betterment  of  medical  practice  in  Maryland  and  to 
the  general  elimination  of  the  numerous  quacks  and  char- 
latans who  had  been  permitted  to  carry  on  their  trade  in  the 
state.  Unfortunately  Governor  Jackson  did  not  give  his  ap- 
proval, and  so  two  years  had  to  go  by  before  its  final  adoption 
by  a  new  Legislature,  and  the  signature  of  Governor  Brown. 


Tuberculosis  Crusade  in  Maryland  77 

This  was  but  the  beginning  of  Dr.  Osier's  efforts  for  better 
state  and  municipal  laws. 

The  almost  unrestricted  prevalence  of  typhoid  fever  in  the 
United  States,  particularly  in  Baltimore,  was  a  source  of 
deep  aggravation  to  him,  and  called  for  the  use  of  all  his 
powers  of  voice  and  pen  to  bring  light  into  the  darkness,  that 
rational  legislative  measures  might  be  inaugurated  to  re- 
strict its  incidence. 

Baltimore  at  this  time  was  without  a  general  system  for  the 
disposal  of  its  sewage.  Backyard  privy  vaults  were  nearly 
universal.  Dr.  Osier  was  strongly  of  the  belief  that  typhoid 
fever  would  be  greatly  reduced  with  the  introduction  of  a 
proper  and  adequate  sewerage  system  and  a  pure  water  supply. 
Note  how  vividly  and  forcefully  he  spoke  at  the  meeting  of 
the  Maryland  Public  Health  Association  held  on  November 
13,  1897,  upon  the  subject  of  mortality  from  typhoid  fever 
as  related  to  these  important  city  improvements : 

The  penalties  of  cruel  neglect  have  been  paid  for  1896;  the  dole 
of  victims  for  1897  is  nearly  complete,  the  sacrifices  will  number 
again  above  200.  We  cannot  save  the  predestined  ones  of  1898,  but 
what  of  the  succeeding  years?  From  which  families  shall  the 
victims  be  selected?  Who  can  say?  This  we  can  predict — they 
will  be  of  the  fairest  of  our  sons  and  of  our  daughters;  they  will 
not  be  of  the  very  young,  or  of  the  very  old,  but  the  youth  in  its 
bloom,  the  man  in  the  early  years  of  his  vigor,  the  girl  just  waken- 
ing into  full  life,  the  young  woman  just  joying  in  the  happiness  of 
her  home.  These  will  be  offered  to  our  Minotaur,  these  will  be 
made  to  pass  through  the  fire  of  the  accursed  Moloch.  This,  to 
our  shame,  we  do  with  full  knowledge,  with  an  easy  complacency 
that  only  long  years  of  sinning  can  give. 

Such  writing  as  this  is  not  only  convincing,  but  is  intensely 
moving,  and  must  have  played  no  small  part  in  securing  the 
desired  end  which  happily  came  before  he  was  to  leave  our 
city,  a  boon  and  a  convenience  to  every  member  of  the  com- 
munity, not  to  speak  of  the  aesthetics  of  the  new  order  when 
street  and  sidewalk  gutters  were  no  longer  redolent  with  the 
morning's  dishwashings. 

Whatever  gives  promise  of  adding  to  the  stock  of  medical 
knowledge    immediately    arouses    Dr.    Osier's    enthusiasm. 


78  Sir  William  Osler,  Baet. 

Early  he  became  interested  in  the  amoebic  theory  of  malaria. 
Well  do  I  remember  his  coming  to  the  Massachusetts  Gen- 
eral Hospital  in  Boston  to  demonstrate  amoebae  in  blood  cor- 
puscles to  Dr.  Fred  Shattuck,  then  the  young  medical  at- 
tendant to  that  hospital.  This  must  have  been  in  1887  or 
1888.  No  effort  of  his  for  good  citizenship,  or  for  the  advance- 
ment of  medicine  was  more  remunerative  than  the  stimulus 
he  gave  in  this  country  to  the  solving  of  the  problem  of  the 
causation,  cure  and  prevention  of  malaria,  a  disease  which 
had  so  sorely  afflicted  the  people  of  states  south  of  Mason 
and  Dixon's  line.  Baltimore  became  the  prime  center  for  its 
study  outside  France  and  Italy,  and  Thayer's  book  written 
in  The  Johns  Hopkins  Hospital  from  Osier's  clinic  marks  a 
salutary  epoch  in  the  history  of  this  mosquito-borne  infection. 

Never  was  it  out  of  Dr.  Osier's  mind  that  a  better  educated 
and  more  widely  read  medical  profession  made  for  better  liv- 
ing conditions  of  the  people,  greater  civic  comfort  and  dimin- 
ished suffering  and  death,  so  in  all  ways  possible  he  en- 
couraged students  and  practitioners  alike  to  greater  learning. 
To  this  end  he  insisted  upon  greater  comradeship  and  larger 
attendance  upon  medical  societies  where  experience  could  be 
interchanged  and  interesting  cases  seen  and  discussed;  he 
also  insisted  upon  enlarged  library  facilities,  and  adequate 
supplies  of  current  medical  magazines  and  standard  books. 
Under  his  inspiration  and  leadership  the  old  state  society  of 
Maryland  took  on  a  new  life,  and  its  library  so  long  moulder- 
ing on  its  shelves  sprang  into  usefulness.  To  him  more  than 
to  any  single  man  does  the  medical  profession  of  Maryland 
owe  its  present  faculty  building  with  its  large  and  growing 
library — a  library  in  which  he  took  no  less  interest  than  in 
his  own.  To  this  extent,  then,  we  must  think  of  him  as 
contributing  enormously  to  the  welfare  of  the  community 
through  an  enlightened  profession  influencing  public  opinion 
in  matters  pertaining  to  health,  sanitation,  and  general, 
hygiene. 

iSTot  less  than  his  trenchant  writing  and  speaking  was  Dr. 
Osier's  own  personality  of  influence  upon  men  and  the  com- 


Tuberculosis  Crusade  in  Maryland  79 

munity;  so  strikingly  straightforward,  so  genial  even  con- 
vivial, so  playful  in  youthful  spirit,  so  enthusiastic  in  help- 
fulness and  sympathy,  so  painstaking  and  so  wise,  he  soon 
had  both  patients  and  acquaintances  alike  in  an  attitude  of 
devotion,  almost,  I  might  say,  of  adoration.  And  although 
he  took  no  official  part  in  the  civic  affairs  of  the  city,  he 
gained  through  his  association  in  the  medical  profession,  by 
reason  of  his  acknowledged  eminence  in  that  profession,  and 
through  his  friends  and  acquaintances,  a  leadership  in  the 
affairs  of  the  city  and  state  which  was  most  powerful  and 
beneficent  even  though  it  was  exercised  in  an  indirect  way. 

From  the  moment  when  Koch  discovered  the  germ  of 
tuberculosis  in  1882,  Dr.  Osier  has  never  lost  interest  in  this 
disease.  He  dwelt  upon  it  in  his  teaching  and  he  insisted  that 
his  students  should  be  familiar  with  it.  When  in  1892  the 
use  of  tuberculin  was  thought  to  be  specific,  he  was  among 
the  first  in  this  country  in  giving  it  a  thorough  trial  in 
the  wards  of  the  hospital.  For  greater  encouragement  to 
the  study  of  the  disease,  which  so  long  has  been  such  a  fatal 
enemy  of  mankind,  he  suggested  and  carried  out  the  establish- 
ment of  a  society  whose  single  purpose  should  be  the  con- 
sideration of  the  history  and  the  various  phases,  clinical  and 
pathological,  of  tuberculosis,  and  this  society  he  named,  after 
the  great  French  student  of  tuberculosis  and  discoverer  of  the 
stethoscope — The  Laennec. 

On  November  14,  1899,  Dr.  Osier  read  an  important  paper 
on  the  "  Home  Treatment  of  Pulmonary  Tuberculosis,"  at 
the  semi-annual  meeting  of  the  faculty  at  Westminster,  and 
on  the  same  day  and  in  the  same  place  Tk.  Charles  S.  Millet  of 
E.  Bridgewater,  Mass.,  described  his  outdoor  sleeping  porches 
for  tuberculous  patients.  This  was  the  first  public  discussion 
of  the  value  of  unlimited  night  air  in  the  cure  of  consumption 
and  marks  a  new  epoch  in  the  method  of  treatment.  Inci- 
dentally I  may  remark  that  at  this  same  meeting  mention  was 
first  made  by  Dr.  Joseph  E.  Oichner  of  the  need  and  desira- 
bility of  a  State  Sanatorium  in  Maryland. 


80  Sir  William  Osler,  Bart. 

On  April  19,  1901,  at  the  invitation  of  Dr.  Osier,  Dr. 
Lawrence  F.  Flick  of  Philadelphia  came  to  Baltimore  and 
before  the  Clinical  Society  delivered  an  address  on  the  "  Regis- 
tration of  Tuberculosis/^  saying  that  Philadelphia  and  New 
York  had  already  inaugurated  such  a  provision.  Dr.  Osier 
urged  that  Maryland  should  do  likewise,  as  in  this  way  the 
location  of  cases  could  be  known  to  the  health  authorities 
and  such  steps  be  taken  as  would  be  of  advantage  to  the  patient 
and  to  the  community. 

By  the  end  of  the  year  1901  there  had  arisen  great  interest 
in  the  tuberculosis  movement,  and  it  was  proposed  that  the 
Legislature  of  January,  1902,  should  pass  new  and  vital  laws 
which  should  be  of  benefit  to  the  whole  people.  To  this  end 
a  big  meeting  in  McCoy  Hall  was  proposed  under  the  auspices 
of  the  Maryland  Public  Health  Association,  the  Medical  and 
Chirurgical  Faculty  of  Maryland  and  the  Laennec  Society. 
Dr.  Osier's  "  fiery  "  speech  thrilled  the  audience : 

Mr.  Chairman  and  my  long  suffering,  patient,  inert  fellow- 
citizens:  ....  now  what  is  our  condition  in  this  city,  and  what 
are  we  doing  for  the  10,000  consumptives  who  are  living  today 
in  our  midst?  We  are  doing,  Mr.  Mayor  and  fellow-citizens,  not 
one  solitary  thing  that  a  modern  civilized  community  should  do. 
Through  the  kindness  of  a  couple  of  ladies — God  bless  them!  — 
I  have  been  enabled  in  the  past  three  or  four  years  to  have  two  of 
the  medical  students  of  The  Johns  Hopkins  University  visit  every 
case  of  pulmonary  consumption  that  has  applied  for  admission  to 
the  dispensary  of  our  hospital,  and  I  tell  you  now  that  the  story 
those  students  brought  back  is  a  disgrace  to  us  as  a  city  of 
500,000  inhabitants.  It  is  a  story  of  dire  desolation,  want  and 
helplessness,  and  of  hopeless  imbecility  in  everything  that  should 
be  in  our  civic  relation  to  the  care  of  this  disease. 

He  then  argues  for  registration,  disinfection  after  death  or 
removal,  a  State  Sanatorium  for  curable  cases  and  a  hospital 
for  advanced  cases,  a  sewerage  system  and  a  hospital  for  con- 
tagious diseases.  This  address  and  others  made  the  same  even- 
ing had  an  effect,  to  wit:  The  Legislature  of  1902  created  a 
Tuberculosis  Commission,  the  Governor  naming  Dt.  Thayer 
as  its  chairman. 


Tuberculosis  Crusade  in  Maryland  81 

All  that  is  progressive  or  worth  while  in  the  Tuberculosis 
Crusade  in  Maryland  followed  thereafter;  the  commission 
with  its  advisors  taking  the  initiative  in  beneficial  measures, 
At  Dr.  John  S.  Fulton's  suggestion  the  commission  decided 
upon  a  tuberculosis  exposition  in  January,  1904,  which 
should  show  graphically  and  practically  the  general  incidence 
of  tuberculosis,  its  methods  of  prevention  and  cure,  its 
aetiology  and  pathology,  its  relations  to  social  and  economic 
problems,  and  a  history  of  its  study  from  the  time  of  Hippoc- 
rates. Such  an  exposition  for  any  single  disease  had  never 
before  been  attempted.  Lectures  and  demonstrations  were 
given  and  the  attendance  not  only  from  Baltimore  but  from 
the  counties  and  from  outside  the  state  was  remarkable.  The 
public  was  intensely  interested  and  the  exposition  "  demon- 
strated that  it  is  both  expedient  and  practicable  to  admit  the 
general  public  to  free  participation  in  the  scientific  knowledge 
of  tuberculosis."    (Editorial,  Md.  Med.  Jour.) 

Dr.  Osier  was  the  moving  spirit  in  this  most  successful 
undertaking  and  it  was  he  who  invited  the  distinguished 
speakers  who  were  heard.  As  a  result  of  this  exposition,  the 
Legislature  of  1904  passed  laws  requiring: 

(1)  Eegistration  of  tuberculosis  in  Maryland,  and 

(2)  Providing  means  and  measures  to  be  administered  by 
the  State  Board  of  Health  for  the  domestic  prophylaxis  of 
consumptives. 

Growing  out  of  this  exposition,  too,  was  the  formation,  fol- 
lowing the  suggestion  of  Dr.  S.  A.  Knopf,  of  the  National 
Association  for  the  Study  and  Prevention  of  Tuberculosis.  In 
this  enterprise  Dr.  Osier  had  a  leading  part.  In  its  organiza- 
tion he  was  made  vice-president,  and  since  his  residence  in 
England  has  been  continued  one  of  the  two  honorary  vice- 
presidents,  Mr.  Roosevelt  being  the  second. 

In  December,  1904,  the  Maryland  Association  for  the  Pre- 
vention and  Cure  of  Tuberculosis  was  formed  and  again  to 
this  local  movement  Dr.  Osier  lent  his  interest  and  enthusi- 
asm. His  last  effort  for  the  tuberculosis  cause  in  Baltimore 
was  to  induce  Mr.  Phipps  to  give  the  sum  of  $10,000  for  a 

6 


82  Sir  William  Osler,  Bart. 

Tuberculosis  Dispensary  at  The  Johns  Hopkins  Hospital. 
This  was  opened  with  addresses  on  February  21,  1905,  Mr. 
Phipps  being  present. 

In  reviewing  thus  briefly  the  activities  of  Sir  William 
Osier  during  his  sixteen  years  in  Baltimore,  I  realize  how 
inadequately  I  have  been  able  to  convey  any  idea  of  his  great 
work  and  influence,  or  the  universal  esteem,  love  and  honor 
in  which  he  was  held  not  only  by  the  people  of  Maryland,  but 
by  the  country  at  large.  I  cannot  believe  that  any  man  ever 
left  our  shores  for  a  new  work  elsewhere  more  deeply  and 
sincerely  missed  by  a  larger  army  of  friends.  His  address  of 
farewell  delivered  before  the  Medical  and  Chirurgical  Faculty 
of  Maryland  April  27,  1905,  on  "  Unity,  Peace  and  Concord  " 
typifies  his  attitude  to  all  his  fellows  both  professional  and  lay. 
In  closing  he  sums  up  this  relationship  in  the  one  word  which 
he  leaves  as  his  benediction — Charity. 


OSLER^S   INFLUENCE   ON   OTHEE  MEDICAL 
SCHOOLS  IN  BALTIMORE 

HIS  RELATION  TO  THE  MEDICAL  PROFESSION 

By  Edward  N.  Brush 

To  estimate  correctly  Osier's  influence  upon  other  medical 
schools  and  upon  professional  thought  and  conduct  would 
require  an  inquiry  into  the  methods  of  medical  teaching  in 
vogue  more  than  a  quarter  of  a  century  ago,  and  into  the  social 
and  professional  relations  of  the  physicians  of  the  city  and 
state  toward  each  other. 

At  about  the  time  of  Osier's  arrival  in  Baltimore  to  assume 
the  duties  of  physician-in-chief  to  The  Johns  Hopkins  Hos- 
pital there  was  a  movement  on  foot  to  improve  and  enlarge 
the  medical  curriculum.  The  University  of  Maryland  in  1889 
announced  that  after  1891  a  compulsory  three-year  course 
would  be  required  in  the  medical  department  with  a  prelimi- 
nary examination  in  English. 

In  March,  1890,  a  call  was  issued  by  the  medical  staff  of 
The  Johns  Hopkins  Hospital,  and  the  medical  faculties  of  The 
University  of  Maryland,  The  College  of  Physicians  and 
Surgeons,  The  Baltimore  Medical  College,  The  Baltimore 
University  and  The  Woman's  Medical  College  for  the  organiza- 
tion of  a  medical  college  association  -with  a  view  to  the  co- 
operation of  all  medical  teaching  bodies  in  bringing  about  a 
three-year  graded  course,  written  and  oral  examinations,  a 
preliminary  examination  in  English  and  laboratory  instruc- 
tion in  chemistry,  histology  and  pathology. 

At  the  meeting  of  the  Medical  and  Chirurgical  Faculty  in 

1889  the  annual  address  was  given  by  Dr.  Osier,  who  took  for 

his  theme  ''  The  License  to  Practice,"  and  undoubtedly  this 

address  gave  an  impetus  to  a  movement,  already  receiving 

support,  for  higher  medical  education  and  a  better  qualified 

student  body. 

83 


84  Sir  William  Osler,  Bart. 

My  own  connection  with  medical  teaching  in  Baltimore  did 
not  begin  until  eight  years  subsequent  to  this  date,  but  I 
realized  before  that  period,  and  have  had  occasion  to  know 
since,  the  great  interest  which  Osier  took  in  promoting  reforms 
in  medical  teaching  not  only  here,  but  in  the  country  at  large, 
the  great  and  lasting  influence  of  his  advice,  and  above  all,  his 
example  as  a  teacher. 

Trained  as  he  had  been  as  a  laboratory  man,  realizing  to  the 
fullest  extent  the  results  which  flowed  from  his  laboratory 
studies  and  their  bearing  upon  the  practical  work  of  the 
hospital  ward  and  the  consulting  room,  as  well  as  in  the  lecture 
hall,  he  urged  the  establishment  of  laboratories. 

Thoroughly  equipped  lahoratories,  in  charge  of  men  thoroughly 
equipped  as  teachers  and  investigators,  is  the  most  pressing  want 
to-day  in  the  medical  schools  of  this  country. 

The  hospital  was,  from  his  point  of  view,  a  college — a  place 
of  teaching,  the  most  essential  part  of  the  machinery  of  a 
medical  school. 

The  systematic  use  of  the  resources  of  the  hospital  which  he 
inaugurated  and  which  he  urged  upon  other  communities  and 
described  in  detail  in  his  address  before  the  New  York 
Academy  of  Medicine  in  1903  found  in  the  minds  of  the  more 
progressive  teachers  of  the  Baltimore  schools  a  ready  accept- 
ance. 

For  those  working  in  my  own  special  field,  it  is  gratifying 
to  believe  that  it  was  a  few  words  spoken  in  his  farewell  address 
at  the  university,  February  22,  1905,  which  gave  an  impetus 
that  resulted  in  the  establishment  of  a  psychiatric  clinic  at  the 
hospital. 

From  his  address  at  the  dedication  of  the  Wistar  Institute 
of  Anatomy  and  Biology  of  the  University  of  Pennsylvania,, 
1894,  I  take  the  following: 

What,  after  all,  is  education  but  a  subtle,  slowly  effected  change, 
due  to  the  action  upon  us  of  the  externals;  of  the  written  record 
of  great  minds  of  all  ages,  of  the  beautiful  and  harmonious  sur- 
roundings of  nature  and  art,  and  of  the  lives  good  or  111  of  our 
fellows — these  alone  educate  us,  these  alone  mould  the  developing 
minds. 


Relation-  to  Other  Medical  Schools  85 

The  whole  career  of  Osier  in  Baltimore,  his  life  here  as  a 
teacher,  hospital  physician,  consultant  and  citizen  was  devoted 
to  the  better  teaching  of  medicine,  to  better  ideals  in  educa- 
tion ;  and  from  his  life,  from  his  example,  proceeded  influences 
which  not  only  moulded  developing  minds,  but  stimulated  all 
who  had  a  real  ambition,  to  teach  and,  in  teaching,  to  learn 
also,  and  develop. 

To  emphasize  sufficiently  his  influence  upon  medical  educa- 
tion is  most  difficult.  One  of  his  constant  pleas  for  other 
schools  was  for  larger  clinical  advantages,  and  better  use  of 
those  already  provided.  In  1897  in  his  address  on  Internal 
Medicine  as  a  Vocation,  before  the  ISTew  York  Academy  of 
Medicine,  he  says: 

To-day  the  serious  problem  confronts  the  professors  in  many  of 
our  schools — how  to  teach  practical  medicine  to  large  classes; 
how  to  give  them  protracted  and  systematic  ward  instruction. 
I  know  of  no  teacher  in  the  country  who  controls  enough  clinical 
material  for  the  instruction  of  classes,  say  of  200  men,  during  the 
third  and  fourth  year. 

Never  a  controversialist,  none  the  less  did  he  bear  a  large 
share  in  the  controversies  of  30  or  more  years  ago,  which 
preceded  and  eventually  brought  about  the  changes  in  the 
methods  of  medical  education  which  have  taken  place  since 
that  time.  His  influence  was  exerted  not  in  argument  or 
controversy,  but  in  the  force  of  example,  by  the  way  in  which 
he  lived  his  ideals  and  induced  others  to  share  them  with  him. 

He  studied  "  to  be  quiet "  and  do  his  "  own  business,^^  "  to 
walk  honestly  toward  them  that  are  without"  and  one  of  his 
chief  pleasures  was  "  to  work  among  [us]  as  a  friend  sharing 
actively  in  [our]  manifold  labors." 

Some  years  ago  I  had  occasion  to  apply  to  him  a  quota- 
tion from  the  presidential  address  of  the  late  Dr.  Charles  M. 
Ellis  before  the  Medical  and  Chirurgical  Faculty  in  1898. 
These  words  seem  to  me  particularly  appropriate  to  Dr.  Osier : 

Many  [doctors]  by  reason  of  natural  endowments  and  acquired 
fitness  elevate  their  lives  to  a  professional  plane  on  which  it  is 
possible  for  an  intellectual  life  to  develop;  and  on  which  it  does 
develop,  not  only  to  individual  suflaciency,  but  to  public  usefulness 


86  Sir  William  Osler,  Baet. 

and  a  public  influence,  that  on  the  one  hand  meets  and  supplies 
public  emergencies  and,  on  the  other,  largely  directs  and  controls 
public  thought  and  movement. 

These  words  from  what  I  know  of  the  intimate  and  friendly 
relations  between  the  two  men  may  well  have  been  brought 
to  the  mind  of  Dr.  Ellis  by  his  knowledge  not  only  of  the 
intellectual  life  of  Dr.  Osier,  but  by  his  appreciation  of  the 
controlling  influence  of  his  mind  upon  public  thought  and 
movement,  particularly  in  professional  circles. 

Very  early  in  his  residence  in  Baltimore,  notwithstanding 
that  he  "  studied  to  be  quiet/^  he  became  a  by  no  means  unim- 
portant factor  in  the  social  life  of  Baltimore  physicians. 

He  so  regulated  his  work  that  he  always  had  a  certain 
amount  of  time  to  give  to  his  friends  in  social  converse,  or  in 
conference  over  the  more  serious  things  of  their  everyday  lives 
and  work. 

He  appreciated  the  difficulties  and  perplexities  which  sur- 
rounded the  lives  of  many  of  his  professional  brethren  and 
many  a  burden  has  been  made  lighter,  many  dark  hours  bright- 
ened, by  his  wise  and  thoughtful  advice  and  his  cheering 
optimism. 

More  than  one  doctor  laboring  amid  discouragement  and 
the  indifference  of  open  opposition  of  his  fellow-citizens,  whose 
lives  he  was  manfully  trying  to  make  more  tolerable,  whose 
surroundings  he  was  endeavoring  to  make  more  healthful,  has 
found  to  his  surprise  that  Osier  had  learned  of  what  he  sup- 
posed was  unknown  beyond  the  bounds  of  his  own  community, 
and  has  received  from  him  words  of  cheer  and  commendation, 
which  were  a  powerful  incentive  to  renewed  effort,  just  when 
all  the  uses  of  the  world  appeared  to  him  "  weary,  stale,  flat 
and  unprofitable." 

His  farewell  address  "  Unity,  Peace  and  Concord "  is  an 
eloquent  recital  of  his  consuming  eagerness  to  be  "  a  servant " 
to  his  brethren  to  do  all  in  his  "  power  to  help  them.'^ 

He  strove  always  to  live  in  unity,  peace  and  concord  with 
his  fellows.  He  strove  with  none — not  that  none  were  worth 
the  strife,  but  because  of  a  deep  conviction  of  the  hatefulness 


Relation  to  Other  Medical  Schools  87 

of  strife.  Those  worth  the  strife  he  won  by  other  and  gentler 
means,  and  bound  them  to  him  by  the  everlasting  chains  of 
friendship. 

In  1881  there  was  formed  in  Baltimore  the  Baltimore 
Monthly  Medical  Eeunion.  It  met  at  the  home  of  members  in 
turn  and  around  the  dinner  table  and  at  the  fireside  many 
friendships  were  made  and  consolidated.  Very  soon  after 
coming  to  Baltimore,  Dlr.  Osier  became  a  member  of  the 
Reunion  and  always  when  he  was  present  at  the  monthly 
gatherings,  as  with  The  McGregor,  where  Osier  sat  was  "  the 
head  of  the  table,^'  the  center  of  conversation,  the  focus  of  wit 
and  wisdom. 

As  in  the  past,  so  in  the  future  in  all  that  makes  for  truth 
and  righteousness,  in  all  that  holds  forth  high  ideals,  in  all 
that  encourages  culture  and  all  the  virtues  of  the  Christian 
gentleman  and  the  ideal  physician  the  name  of  Osier  will  be 
one  to  conjure  with.  From  time  to  time,  as  on  the  present 
occasion,  his  friends  for  many  years,  let  us  hope,  will  send 
him  greetings  across  the  sea.  He  has  given  us  the  master  word 
and  with  that  in  our  hearts  all  things  are  possible.  Have  we 
not  seen  it  exemplified  in  his  life  and  character  ? 


88  SiE  William  Oslee,  Baet. 


ON   A   PORTRAIT    OP   SIR    WILLIAM   OSLER,    BART. 

William  tlie  Fowler,   Guillaume   I'Oiseleur! 
I  love  to  call  him  thus  and  when  I  scan 
The  counterfeit  presentment  of  the  man, 
I  feel  his  net,  I  hear  his  arrows  whir. 
Make  at  the  homely  surname  no  demur, 
Nor  on  a  nomination  lay  a  ban 
With  which  a  line  of  sovran  lords  began, 
Henry  the  Fowler  was  first  Emperor. 

Asclepius  was  Apollo's  chosen  son. 

But  to  that  son  he  never  lent  his  bow, 

Nor  did  Hephaestus  teach  to  forge  his  net; 

Both  secrets  hath  Imperial  Osier  won. 

His  winged  words  straight  to  their  quarry  go. 

All  hearts  are  holden  by  his  meshes  yet. 

Basil  L.  Gildersleeve 


Painted  by  Seyninur  Tliomas,  190S 

Sir  Willia:\e  Oslek,  Bart. 


INFLUENCE  IN  BUILDING  UP  THE  MEDICAL  AND 
CHIEUEGICAL  FACULTY 

By  Hiram  Woods 

"  Influence  in  Building  Up  the  Medical  and  Chirurgical 
Faculty  '^  is  a  theme  one  might  approach  from  numerous 
paths.  So  great  was  Dr.  Osier's  influence,  in  so  many  direc- 
tions did  it  work,  so  broad  was  his  conception  of  the  possi- 
bilities for  good  in  the  organization,  so  keen  his  appreciation 
of  the  obstacles  to  progress,  some  traditional,  some  personal, 
that  the  many-sided  subject  is  bound  to  appeal  to  his  friends 
in  different  ways.  Adequate  organization  of  the  library ;  reve- 
lation to  the  younger  man  of  what  the  library  even  in  those 
days  afforded ;  provision  for  the  purchase  of  new  books — these 
are  themes  which  have  been  selected  for  special  review  and 
will  be  presented  by  others.  I  shall  try  to  give  some  idea  of 
his  work  from  another  standpoint — that  of  personal  influence. 
Yet,  with  the  selection  of  this  special  topic,  I  am  aware  that 
I  shall  speak  from  my  own  personal  impressions  and  memory 
and  may  fail  utterly  to  express  the  feelings  of  another  just  as 
indebted  to  Dr.  Osier  as  am  I. 

I  have  asked  myself.  What  were  Dr.  Osler^s  basic  thoughts 
and  principle  in  his  work  for,  and  devotion  to,  the  State 
Medical  Society?  He  held  the  most  influential  position 
medicine  in  Baltimore  could  give ;  he  had  at  command  greater 
powers  than  any  one  medical  man  had  ever  possessed  in  the 
city ;  his  teaching  and  organization  duties  in  the  new  medical 
school  were  exacting  enough  to  take  all  his  time,  and  yet  he 
went  to  work  on  the  state  society  in  a  way  which  soon  gathered 
recruits  happy  to  work  under — not  his  direction — but  his 
mind  and  heart.  What  led  him  to  do  it  ?  I  think  he  felt  that 
the  biggest  medical  foundation  Baltimore  had  ever  had  ought 
to  benefit  the  existing  profession.  He  thought  there  should 
be  a  high  valuation  of  the  profession  itself ;  realization  of  the 

89 


90  Sir  William  Oslee,  Bart. 

obligation  of  self -improvement ;  a  breaking-down  of  the 
"  middle  wall  of  partition  "  between  those,  who,  by  a  connec- 
tion with  the  new  school,  seemed  to  possess  an  advantage,  more 
or  less  adventitious,  and  those  who  found,  or  thought  they  did, 
a  definite  obstacle  to  practice  in  the  new  Foundation.  He  felt 
the  meaning  of  "  Unity .'^  He  told  us  of  this — at  least  in 
words — only  on  the  eve  of  his  departure.  And  yet  he  had  told 
us  about  it  previously  in  a  better  way.  Go  over  the  papers  he 
brought  to  the  faculty  meetings  and  the  smaller  gatherings  of 
the  local  society  and  you  will,  if  I  mistake  not,  see  that  he 
presented  the  problems  of  disease,  cause,  prevention  and  cure, 
as  the  same  for  the  hard-worked  country  doctor,  with  little 
time  to  read,  and  the  man  with  hospital  and  laboratory 
advantages,  plus  trained  nurses  and  competent  assistants.  But 
here  the  roads  parted,  in  a  sense.  The  practitioner  brought 
his  experiences  and  difficulties.  Modern  methods  of  investi- 
gation were  not  at  his  command.  Dr.  Osier  felt  that  the  man 
with  greater  advantages  should,  in  the  first  place,  qualify  him- 
self to  understand  the  point  of  view  of  his  less  fortunately 
placed  colleague,  and  then,  from  his  greater  advantages,  make 
up  the  deficiency. 

Sometimes  a  chance  thing  makes  a  life-long  impression,  and 
such  an  occurrence  has  come  back  to  me  time  and  again.  At  a 
society  meeting  typhoid  fever  was  the  topic.  I  believe  I  am 
quoting  accurately :  "  Typhoid  fever,  the  monster  that  de- 
stroys the  best  of  our  sons  and  claims  the  fairest  of  our 
daughters ;  are  we  to  let  it  continue  or  stop  it  ?  "  And  then 
followed  a  clear,  scientific  and  yet  almost  a  domestic  demon- 
stration of  preventive  measures  which  could  be  taken  home 
and  taught  to  those  who  did  not  know,  but  who,  if  they  knew, 
might  save  their  own  and  others'  lives.  This,  I  believe,  was 
Dr.  Osier's  motive  force :  aim  to  realize  the  other  man's  point 
of  views  and  his  needs,  and  to  reach  these  needs  if  he  could. 
But  if  such  was  the  self-imposed  task,  success  could  come  from 
no  wiser-than-thou  attitude.  There  had  to  be  a  comradeship ; 
not  the  assumed,  patronizing  variety,  but  the  sort  that  cements 
the  minds  and  hearts  of  men  earnest  after  the  same  thing — 


Medical  axd  Chirurgical  Faculty  91 

knowledge.  How  many  of  ns  have  met  him  browsing  around 
in  the  library,  and  soon  found  ourselves  just  talking?  Yet 
from  that  talk  we  afterwards  found  we  had  gleaned  a  great 
deal.  It  was  from  one  such  talk  that  I  took  away  definite 
impressions  about  the  evils  of  narrow  specialism.  Again,  after 
we  got  to  know  him  better,  we  would  sometimes  find  him  in 
deep  conversation  with  a  beginner  in  medicine,  or  a  man  we 
hardly  knew,  and  we  shied  oif.  It  was  perfectly  clear  what  he 
was  doing.  But  the  comradeship  was  the  real  thing;  there 
was  nothing  professorial  about  it.  This  comradeship  extended 
beyond  the  confines  of  men  who  were  active  students  for  their 
own  good  or  those  who  needed  prodding.  It  went  after  and 
reached  those  who  had  something  to  give,  and  who  did  not 
know  how  to  give  it;  maybe  they  did  not  know  they  had  it. 
There  are  matters  of  importance  to  the  faculty  and  profession, 
bearing  others^  names,  which  would  never  have  come  into  being 
without  William  Osier's  realization  of  their  importance  and 
pointing  out  the  way  to  achievement.  I  cannot  speak  more 
definitely;  but  men  familiar  with  the  faculty's  history  will 
know.  This  comradeship  went  farther.  It  reached  those  who 
for  one  reason  or  another  had  met  with  little  or  no  success. 
It  made  them  feel  that  in  spite  of  what  might  be  termed 
failure,  honesty  of  purpose  gave  standing  to  a  man  in  medicine 
and  brought  him  into  unity  with  his  brothers  upon  whom 
fortune  had  smiled  more  kindly. 

Work  for  the  library,  teaching  its  value  by  precept  and 
example,  demonstrating  the  unity  of  the  medical  profession 
and  the  spirit  of  comradeship  soon  won  the  esteem,  confidence 
and  affection  of  men  throughout  our  state.  This  feeling  was, 
possibly,  best  expressed  in  a  telegram  sent  to  Dr.  Osier's 
mother  in  April,  1905,  when  he  was  about  to  leave  Baltimore. 
The  telegram  was  sent  by  vote  of  the  faculty  at  its  annual 
meeting  and  signed  by  the  president,  Samuel  T.  Earle.  It 
reads : 

The  greetings  of  the  Medical  and  Chirurgical  Faculty  of  Mary- 
land to  Mrs.  Osier,  asking  her  to  share  their  sentiments  in  taking 
leave  of  William  Osier,  congratulating  Mrs.   Osier  first  on  the 


92  Sir  William  Osler,  Bart. 

distinguished  career  of  her  son,  but  most  on  the  innate  qualities 
which  have  endeared  him  to  his  associates  in  Maryland. 

A  few  days  later  the  following  reply  was  received : 
Mrs.  Osier,  who  is  unable  from  her  great  age  to  write,  asked 
me  to  express  her  heartfelt  thanks  to  you  for  the  very  kind  tele- 
gram of  greeting  sent  through  you  from  the  Medical  and  Chi- 
rurgical  Faculty  of  Maryland,  and  to  say  that  the  receipt  of  the 
message  gave  her  the  greatest  pleasure,  more  especially  in  the 
expression  of  affection  and  appreciation  called  forth  by  the 
personal  qualities  of  her  son,  since  these  are,  in  her  eyes,  more 
precious  than  all  his  honors. 

She  knows  that  it  must  be  hard  for  him  to  sever  his  connection 
with  such  kind  confreres,  and  she  is  sure  that  the  friendships  he 
has  made  during  his  residence  in  the  States  will  be  among  his 
most  cherished  memories.    I  am,  sir,  yours  sincerely, 

Jeannette  Oslee. 

One  who  had  thrown  his  heart  and  soul  into  an  enterprise 
would  be  keenly  disappointed  if  his  work  fell  through  in  later 
years.  There  seems  no  danger  of  this  while  there  survive  the 
men  who  came  under  Dr.  Osier's  leadership.  The  funds 
obtained  through  his  influence^  and  others,  which  have  come 
sincC;,  because  of  the  spirit  he  put  into  the  organization,  are 
keeping  the  faculty  up  to  date.  But  these  material  things, 
important  as  they  are,  would  fail  in  their  purpose,  unless 
something  else  lived  and  permeated  the  faculty's  life.  I 
mean  the  mental  attitude  which  I  have  tried  to  present.  It  is 
interesting  to  go  over  a  book  in  a  public  library  even  if  one 
owns  a  copy  himself.  The  latter  he  feels  free  to  mark,  but  it 
demands  a  certain  amount  of  bad  taste  to  mark  passages  in  a 
book  which  does  not  belong  to  you.  However,  this  bad  taste 
does  exist  here  and  there  and  sometimes  it  may  not  be  without 
its  advantages.  It  shows  the  other  fellow's  thought.  Eecently 
I  picked  up  ^'  Aequanimitas  "  at  the  library  and  opened  by 
chance  at  the  delightful  essay  "  Teacher  and  Student."  That 
a  library-worn  book  like  this  should  open  right  there  is  not 
without  significance.  It  means  that  there  are  youngsters 
coming  on  now  who  are  getting  from  the  printed  page  some 
of  the  things  others  got  from  personal  intercourse.  This 
passage  is  marked  with  a  heavy  lead  pencil : 


Medical  and  Chirurgical  Faculty  93 

The  measure  of  value  of  a  nation  to  the  world  is  neither  the 
bushel  nor  the  barrel,  but  mind; — Wheat  and  pork,  though  useful 
and  necessary,  are  but  dross  in  comparison  with  those  intellectual 
products  which  alone  are  imperishable. 

In  "  Unity,  Peace  and  Concord,"  written  in  1905,  13  years 
after  the  essay  to  which  allusion  has  been  made,  Dr.  Osier 
speaks  of  "  the  petition  in  the  Litany  in  which  we  pray  that 
to  the  nations  may  be  given  unity,  peace  and  concord/^  Then 
follows  this,  which  I  do  not  attempt  to  summarize : 

Century  after  century  from  the  altars  of  Christendom  this 
most  beautiful  of  all  prayers  has  arisen  from  lips  of  men  and 
women,  from  the  loyal  souls  who  have  refused  to  recognize  its 
hopelessness,  with  the  war-drums  ever  sounding  in  their  ears. 
The  desire  for  unity,  the  wish  for  peace,  the  longing  for  concord, 
deeply  implanted  in  the  human  heart,  have  stirred  the  most 
powerful  emotions  of  the  race,  and  have  been  responsible  for 
some  of  its  noblest  actions.  It  is  but  a  sentiment,  you  may  say, 
but  is  not  the  world  ruled  by  feeling  and  by  passion?  ....  As 
with  the  nations  at  large,  so  with  the  nation  in  particular;  as 
with  people,  so  with  individuals,  and  as  with  our  profession,  so 
with  its  members,  this  fine  old  prayer  for  unity,  peace  and  con- 
cord, if  in  our  hearts  as  well  as  on  our  lips,  may  help  us  to 
realize  its  aspirations. 

Now,  14  years  later,  with  the  world  still  ^^ refusing"  to 
recognize  its  '^  hopelessness  "  and  struggling  toward  the  reali- 
zation of  permanent  unity,  peace  and  concord,  these  words 
seem  almost  prophetic.  From  the  "  nations  at  large  "  through 
successive  steps,  this  great  principle  of  unity,  peace  and 
concord  reaches  the  medical  profession  and  ^'  individual " 
doctor.  His  comprehension  and  use  of  it  will  depend  on  his 
relative  valuation  of  the  "  barrel  and  bushel "  and  "  mind." 
Dr.  Osier's  method  of  upbuilding  the  faculty  differed  from 
others'  in  that  he  aimed  to  increase  the  individual's  receptivity 
for  what  the  faculty  had  to  offer.  So  long  as  the  faculty  sees 
its  responsibility  to  offer  only  the  best;  so  long  as  its  members 
appreciate  the  nature  of  what  is  offered  and  remember  that 


94  Sir  William  Osler,  Bart. 

profit  is  a  question  of  their  own  hearts  and  minds,  there  will 
be  no  danger  of  deterioration ;  but  both  are  necessary.  While 
we  are  congratulating  Dr.  Osier  and  gratefully  acknowledging 
our  debt  to  him,  let  us  not  forget  what  his  example  taught ; 
for  it  is  only  thus  that  we  can  keep  what  he  had  so  large  a 
share  in  giving  us. 


OSLER  AND  THE  BOOK  AND  JOURNAL  CLUB 
By  J.  A.  Chatard 

Of  all  the  varied  activities  and  interests  that  occupied  Sir 
William  Osier,  while  in  Baltimore,  possibly  none  appealed  to 
him  personally,  and  to  the  little  group  of  supporters  that  he 
gathered  about  him  in  the  early  days  of  1896,  more  than  the 
idea  of  getting  together  a  few  of  the  men  of  the  profession  at 
periodic  times  for  the  discussion  of  old  books  on  medical  sub- 
jects and  the  presentation  of  papers  on  the  historical  side  of 
medicine.  At  the  same  time  the  members,  by  their  interest 
in  the  work  and  by  the  voluntary  subscriptions  offered,  helped 
much  in  the  improvement  of  the  library  of  the  Medical  and 
Chirurgical  Faculty  by  the  purchase  of  new  books  and  journals. 

In  these  early  90's  the  faculty  was  in  a  quiescent  mood  with 
few  regular  meetings  at  which,  for  the  most  part,  only  routine 
business  was  transacted.  Eor  lack  of  funds  the  library  was 
much  neglected  and  the  book  and  journal  files  were  far  from 
complete.  This  Dr.  Osier  saw  and  at  once  put  his  great 
store  of  knowledge  and  earnestness,  at  the  disposal  of  the 
members  of  the  faculty,  with  the  result  that  the  Book  and 
Journal  Club  was  soon  in  a  flourishing  condition. 

Those  of  us  who  went  to  the  early  meetings  can  still  remem- 
ber the  enthusiasm  of  Dr.  Osier  in  his  presentation  of  rare  old 
historical  medical  subjects  or  in  the  enlightening  discussion 
that  he  gave  following  someone  else's  paper.  x\fter  some 
time  he  would  then  show  some  of  the  fine  old  books  illustrating 
the  talk,  these  books  not  infrequently  coming  from  his  own 
medical  library. 

But  for  one  man's  enthusiasm  and  zeal  we  might  have 
missed  so  many  interesting  talks  on  the  "  Hippocratic  Writ- 
ings," the  "  Plague  of  1630  in  Milan,"  "  Harvey  as  an  Embry- 
ologist,"  "  Some  Diseases  Bearing  the  Names  of  Saints," 
"  The   Resurrectionists   of  London   and   Edinburgh,"   "  The 

95 


96  Sir  William  Osler,  Bart. 

Books  of  Yesalius/^  "Assyrian  Medicine/'  and  last  but  not 
least;,  our  old  friend  Sir  Thomas  Browne.  These  and  so  many 
other  historical  subjects  he  was  instrumental  in  bringing  be- 
fore us^  leading  us  on  to  browse  among  the  old  masters  and 
find  there  the  very  things  we  may  be  looking  for  to-day. 

During  his  presidency^  the  Book  and  Journal  Club  collected 
over  five  thousand  dollars  by  voluntary  subscription  and  in 
addition  to  paying  for  the  binding  of  many  journals,  we  were 
able  to  purchase  annually  about  270  books  and  subscribe  to 
56  journals.  To  those  of  us  who  know  how  crippled  the 
finances  of  the  faculty  were  at  that  time,  and  how  little  was 
available  for  the  library  fund,  this  money  from  the  Book  and 
Journal  Club  was  a  treasure  indeed. 

To  the  older  members  of  the  faculty  his  work  and  zeal  for 
their  interests  was  of  wonderful  help  and  assistance,  and  his 
close  association  with  them  will  always  be  looked  back  on 
with  the  deepest  and  most  lasting  pleasure.  To  the  younger, 
some  of  whom  are  now  among  the  older  members  of  the 
faculty,  who  knew  him  at  that  time  and  worshipped  from  afar, 
his  example  should  be  a  help  to  be  better  students  and  workers. 
To  the  youngest  members  of  the  faculty,  who,  alas,  knew  him 
not,  it  becomes  a  duty  to  emulate  his  efforts  in  historical  study 
and  so  join  in  the  company  of  those  who  can  find  that  all  is 
not  dry  and  musty  in  the  old  discolored  books  upon  our  shelves. 
It  is  only  by  thus  fostering  and  helping  along  a  search  for  old 
truths  that  the  newer  ones  assume  a  more  crystalline  appear- 
ance and  we  are  better  able  to  value  them  in  the  light  of 
advancing  thought. 


OSLEE^S  INFLUENCE  ON  THE  LIBRARY  OF  THE 

MEDICAL  AND  CHIRURGICAL  FACULTY 

OF  THE  STATE  OF  MARYLAND 

By  Marcia  C.  Notes,  Librarian 

Associations  of  Dr.  Osier  are  so  interwoven  with  the  library 
of  the  Medical  and  Chirurgical  Faculty  that  what  we  have 
become  is,  in  reality,  but  an  expression  of  what  we  felt  he 
would  have  us  be. 

The  name  of  Osier  is  writ  large  in  the  history  of  the  library 
from  the  time  of  his  first  connection  with  it  in  1890;  and  the 
impression  made  by  his  character  on  the  lives  of  those  with 
whom  he  came  in  contact  has  been  a  powerful  influence  for 
the  betterment  of  medicine  in  Maryland  and  in  the  upbuild- 
ing of  the  state  society  and  its  library. 

Dr.  Osier  was  elected  a  member  of  our  Library  Committee 
in  1892  in  which  jeai  the  committee  reported  difficulties,  finan- 
cial and  otherwise,  in  the  management  of  this  "  most  valued 
and  noble  inheritance."  Although  never  serving  as  chairman, 
that  he  lent  himself  to  the  surmounting  of  these  difficulties 
we  know,  and  what  was  accomplished  between  1892  and  1905, 
his  tenure  of  office  on  the  Library  Committee,  is  given,  in 
part,  herewith.*  From  a  collection  of  a  few  thousand  old 
books  in  1892,  it  grew  to  14,590  volumes  in  1905,  and  has 
grown  steadily  ever  since. 

The  library,  which  dates  from  1830,  had  been  partially 
revived  in  1881  and  was  housed  in  rooms  in  the  basement  of 
the  old  Maryland  Historical  Society  in  1885;  but  it  was 
Dr.  Osler^s  interest  which  brought  about  its  renaissance  and 
the  purchase  of  and  its  removal  to  the  home  at  847  N.  Eutaw 

*  When  abroad  for  his  annual  outing,  Dr.  Osier  always  had  the 
needs  of  our  Library  in  mind,  and  we  owe  many  of  its  greatest 
treasures  to  his  interest.  Some  of  these  were  a  direct  gift  from 
him,  and  others  selected  for  purchase  on  the  Frick  Fund. 

97 


98  Sir  William  Osler,  Bart. 

Street  (Hamilton  Terrace)  in  1895.  After  a  year  without 
proper  supervision  it  was  owing  to  Dr.  Osier,  who  personally 
saw  to  it,  that  the  Library  Committee  employed  a  trained 
worker  and  the  present  librarian  took  charge.  To  him  we  owe 
the  founding  of  the  Charles  Frick  section  of  the  library,  in 
1896,  which  was  made  possible  by  the  generosity  of  Messrs. 
William  F.  and  Frank  Frick;  and  the  establishment  of  the 
Book  and  Journal  Club  at  about  the  same  time.  These  funds 
gave  the  library  a  definite  income  for  the  first  time  in  its 
history. 

Dr.  Osier  was  president  of  the  Faculty  in  1896-1897,  and  in 
his  presidential  address,  April,  1897,  in  outlining  the  purpose 
of  the  Book  and  Journal  Club,  and  of  the  Frick  memorial 
said :  "  I  envy  Charles  Frick  the  good  fortune  to  go  down  to 
the  future  generations  in  this  Faculty  with  his  name  linked 
to  an  important  section  of  our  library.  Posthumously  and  by 
proxy,  as  it  were,  thus  to  carry  on,  though  dead,  the  work 
he  was  interested  in  while  living,  is  the  nearest  approach  a 
man  can  make  to  cheating  the  great  enemy,  and  in  Charles 
Frick^s  case  it  is  in  a  measure  a  compensation  for  the  untime- 
liness  of  his  taking  off.^^  He  also  spoke  of  the  approaching 
centennial  as  follows :  "  We  can  try  in  the  centennial  year  to 
obtain  a  proper  endowment  for  the  Faculty  from  our  friends 
among  the  citizens.  We  shall  need  a  larger  hall,  more  in 
keeping  with  the  rank  and  work  of  the  profession  of  this 
city — quarters  as  complete  as  our  brethren  enjoy  in  Philadel- 
phia and  'New  York.  And  an  endowment  yielding  a  few 
thousand  dollars  annually  is  absolutely  essential  for  the  proper 
development  of  the  library."  At  the  centennial  of  the  Faculty 
in  1899  he  gave  the  first  thousand  dollars  toward  such  an 
endowment  fund;  and  it  may  safely  be  said  that  it  was  prin- 
cipally due  to  his  influence  that  the  Charles  M.  Ellis  bequest 
was  made  in  1910. 

It  was  because  of  the  widespread  desire  to  honor  Dr.  Osier 
that  the  present  home  of  the  library,  at  1211  Cathedral  Street, 
became  a  fact  in  1909;  and  because  of  a  further  expression  of 
this  desire  that  the  Osier  Testimonial  Fund  for  the  purchase, 


Medical  and  Chirurgical  Faculty  Library       99 

in  his  name,  of  books  on  medicine  was  presented  to  us  in  1917. 
It  is  singularly  fitting  that  his  name  should  be  linked  for  all 
time  with  that  of  the  Medical  and  Chirurgical  Faculty  and 
its  library,  for  he  delighted  so  keenly  in  the  phrasing  of  the 
old  title — the  chirurgical,  so  hard  for  the  uninitated  to  pro- 
nounce— and  in  the  usage  of  the  word  faculty  instead  of 
society.  The  development  of  the  library,  to  its  fullest  extent, 
interested  him  beyond  measure,  for  he  was  not  only  a  lover, 
but  a  user  of  books,  and  he  insisted  that  his  students  should 
learn  the  art.  The  familiar  slip  bearing  his  reference  was 
presented  almost  daily  by  some  one  of  them,  and  our  reading 
room  on  Saturday  afternoons  became  a  rendezvous  for  students 
and  physicians  who  thought  to  meet  him  there  to  seek  his 
advice.  In  those  days,  the  pausing  of  a  hansom  at  the  door, 
if  followed  immediately  by  a  cheery  whistle,  presaged  his 
advent  to  the  initiated.  Hardly  a  Saturday  passed  without 
Dr.  Osier  coming  to  scan  the  shelves  containing  the  new 
journals  and  to  browse  among  the  books  to  be  found  in  the 
Charles  Frick  Eeading  Eoom. 

Akin  to  his  interest  in  books  is  his  interest  in  medical 
libraries  in  general,  and  he  was  intimately  familiar  with  and 
always  a  welcome  guest  at  the  library  of  the  Surgeon  General's 
Office,  the  College  of  Physicians  of  Philadelphia,  the  N"ew 
York  Academy  of  Medicine,  the  Boston  Medical  Library  and 
the  library  at  McGill  University,  as  well  as  the  libraries  in 
Baltimore  and  many  of  the  smaller  medical  libraries  elsewhere, 
some  of  which  he  fostered.  He  was  not  only  familiar  with  the 
books  in  these  collections,  but  he  knew  intimately  the  cata- 
logers  and  workers  who  do  not  usually  come  in  contact  with 
the  readers,  as  well  as  the  Librarians  in  charge. 

This  interest  found  expression  in  the  founding,  in  conjunc- 
tion with  Dr.  George  M.  Gould,  of  Philadelphia,  of  the  Medical 
Library  Association  in  1898.  Owing  to  his  generosity  our 
library  was  a  member  from  the  beginning,  and  has  become  an 
influence  in  the  medical  world  because  of  this  membership  and 
our  connection  with  the  exchange  of  the  association. 


100  Sir  William  Osler,  Bart. 

ISTo  one  man  has  so  left  his  imprint  on  the  libraries  of  two 
continents  as  has  Sir  William  Osier,  and  a  quotation  from  his 
address  "  Books  and  Men  "  delivered  in  1901  at  the  opening 
of  the  new  building  of  the  Boston  Medical  Library,  at  8  The 
Fenway,  sums  up  what  his  example  has  meant  to  this  library 
and  Faculty: 

It  is  hard  for  me  to  speak  of  the  value  of  libraries  in  terms 
which  would  not  seem  exaggerated.  Books  have  been  my  delight 
these  thirty  years,  and  from  them  I  have  received  incalculable 

benefits For  the  teacher  and  the  worker  a  great  library 

such  as  this  is  indispensable.    They  must  know  the  world's  best 

work  and  know  it  at  once For  the  general  practitioner 

a  well-used  library  is  one  of  the  few  correctives  of  the  premature 
senility  which  is  so  apt  to  overtake  him.  Self-centered,  self- 
taught,  he  leads  a  solitary  life,  and  unless  his  everyday  experi- 
ence is  controlled  by  careful  reading  or  by  the  attrition  of  a 
medical  society  it  soon  ceases  to  be  of  the  slightest  value  and 
becomes  a  mere  accretion  of  isolated  facts,  without  correlation. 


I 


fe 


o 


SOME  EARLY  REMINISCENCES  OF 
WILLIAM  OSLER 

By  Henry  M.  Hurd 

In  September,  1883,  while  on  a  vacation  trip  with  a  friend, 
I  stopped  at  Kingston,  Ontario,  and  found  myself  in  a  busy 
throng  of  physicians  in  attendance  upon  the  Canadian  Medical 
Association  in  annual  session  there.  The  physicians  were 
diligent  in  their  attendance  upon  the  meetings  of  the  associa- 
tion, proud  of  their  mutual  calling  and  eager  to  advance  it. 
The  secretary  of  the  organization,  and  one  of  the  leading 
spirits,  was  Dr.  Osier,  a  resident  of  Montreal,  a  young  man  of 
34  years,  who  then,  as  always,  appeared  younger.  He  knew  in 
person  every  physician  present  and  was  easily  the  guiding 
force  in  the  association.  He  participated  freely  in  the  discus- 
sions which  followed  the  reading  of  papers  and  did  not  hesi- 
tate to  express  his  mind  freely  and  frankly  on  all  important 
questions.  In  the  meetings  there  were  the  usual  differences  of 
opinion  between  the  rank  and  file  of  the  profession  and  the 
members  of  the  medical  examining  board  and  verbal  en- 
counters sometimes  took  place  between  many  men  of  different 
minds.  Osier  spoke  boldly  and  without  reserve  and  had  an 
opinion  upon  all  matters,  but  never  seemed  to  excite  ill  feeling 
or  lasting  resentment  on  the  part  of  those  who  differed  with 
him.  He  was  an  excellent  secretary  and  carefully  watched 
the  progress  of  the  special  work  of  the  meetings.  He  was 
spare  in  figure,  with  a  sharp,  piercing  eye,  and  although  of 
sallow  complexion,  was  vigorous  and  in  excellent  health.  He 
was  neatly  and  quietly,  but  carefully  dressed  and  in  manner 
and  bearing  displayed  the  characteristics  which  I  later  learned 
to  recognize  and  appreciate  as  peculiar  to  him.  One  circum- 
stance in  the  meeting  attracted  my  attention  in  a  special  way ; 
a  prominent  member  read  a  paper  entitled  "  The  Conduct  of 
Medical  Men  Towards  Each  Other  and  Towards  Each  Others' 

101 


103  Sir  William  Osler,  Bart. 

Patients/^  wMch  displayed  great  wrong-headedness  and  per- 
versity of  feeling  in  reference  to  the  relations  of  physicians  to 
each  other  in  the  matter  of  consultations  over  very  ill  patients. 
He  held  that  a  physician  was  justified,  when  called  in  con- 
sultation, in  getting  control  of  his  brother  practitioner's 
patient  and  concluded  by  saying :  ^'  Take  all  the  cases  you 
can  get  and  keep  them  if  you  can  without  reference  to  the 
rights  of  any  other  attending  physician.^'  He  also  deemed  it 
justifiable  to  report  one's  cases  of  operations  or  extraordinary 
cures  in  the  newspapers  and  inquired,  "Why  should  not 
medical  men  report  their  cases  as  well  as  a  lawyer  his  speeches 
or  a  clergyman  his  sermons  ?  "  When  he  had  concluded  read- 
ing his  paper  he  was  called  sharply  to  order  by  several  members 
and  referred  to  the  Code  of  Ethics  which  existed  in  Canada  to 
govern  the  relations  of  physicians  to  each  other.  Whereupon 
the  offender  announced  that  he  had  never  seen  any  such  code 
and  that  it  had  no  meaning  to  him.  Dr.  Osier  sprang  to  his 
feet  and  drew  from  his  pocket  a  pamphlet  copy  of  the  Code  of 
Ethics  which  he  waved  about  his  head  and  in  a  loud,  clear 
voice  announced  that  he  took  great  pleasure  in  supplying  a 
copy  to  his  innocent  and  untutored  friend  and  was  glad  to 
learn  that  he  had  "  sinned  unwittingly  through  ignorance." 

In  1889,  when  I  came  to  Baltimore,  I  found  Dr.  Osier  in 
temporary  charge  of  The  Johns  Hopkins  Hospital,  which  had 
been  open  in  part  for  a  few  weeks.  He  lived  at  the  hospital 
and  guided  its  work  in  company  with  Dr.  Halsted  and  such 
members  of  the  early  staff  as  Lafleur,  Brockway,  Clarke  and 
others.  I  remember  on  my  first  visit  while  walking  along 
Broadway  in  company  with  Osier  and  President  Oilman,  the 
day  being  very  hot,  the  latter,  as  usual,  had  an  umbrella  which 
he  used  to  protect  himself  against  the  rays  of  the  sun.  He 
invited  Osier  to  walk  with  him,  who  declined  saying,  "  The 
chill  of  nearly  40  Canadian  winters  is  still  in  my  veins  and  I 
do  not  need  any  such  shelter." 

He  was  a  delightful  companion  with  children  and  took  much 
pleasure  in  conversing  with  them  and  even  mystifying  them 
by  detailing  remarkable  personal  experiences  and  sometimes 


Early  Reminiscences  103 

tragedies.  Once  he  invited  two  young  girls  to  a  luncheon  at 
his  house  on  Monument  Street,  where  his  niece,  now  Mrs. 
Abbott,  kept  house  for  him.  He  came  late  to  luncheon  and 
explained  his  delay  by  the  fact  that  he  had  been  caught  in  a 
down-pour  of  rain  when  crossing  Monument  Square  which 
had  produced  a  flood  sweeping  him  off  his  feet;  that  he  had 
escaped  only  after  vigorous  swimming  and  had  barely  saved 
himself  by  grasping  the  shaft  of  the  Washington  Monument 
with  both  arms.  A  more  harrowing  tale  was  that  of  the  loss 
of  a  young  friend  by  falling  from  his  row-boat  into  the 
St.  Lawrence  River.  He  explained  that  he  might  have  rescued 
her  had  he  not  resolved  never  to  act  hastily  and  without  due 
consideration.  He  had  accordingly  tossed  up  a  coin  to  deter- 
mine what  his  action  should  be.  It  fell  adversely  and  he 
rowed  ashore  alone  weeping  bitterly !  Fancy  the  difficulty  of 
duly  impressing  high  moral  precepts  upon  the  young  in  the 
light  of  such  a  confusing  example.  Children  delighted  in  his 
presence  and  were  charmed  by  him,  but  very  naturally  were 
always  uncertain  as  to  the  logical  nature  of  his  conclusions 
and  equally  puzzled  by  his  apparent  indifference  to  conven- 
tional conceptions  of  duty  and  obligation.  There  was  also  in 
his  attitude  towards  pupil  nurses  a  similar  light-hearted 
irresponsibility  which  marked  some  portion  of  two  addresses 
to  nurses  to  which  reference  is  made  later.  It  is  possible, 
however,  to  perceive  that  under  the  cloak  of  these  apparent 
trivialities  there  lurked  a  seriousness  of  purpose  and  a  keen 
desire  to  point  a  painful  moral  in  a  kindly  way.  With 
children,  however,  it  was  simply  an  expression  of  his  ample 
imagination  and  of  his  desire  to  please  and  puzzle  them.  Even 
older  people  were  sometimes  at  a  loss  to  follow  his  moods  and 
strange  fancies.  He  was  invariably  cheerful,  hopeful,  and 
optimistic  even  under  circumstances  of  discouragement  and 
doubt.  I  remember  on  one  occasion  one  of  his  colleagues, 
mystified  by  his  imperturbability  in  a  trying  emergency  said, 
"  Osier  drop  your  mask,  let  us  know  what  you  actually  think 
of  the  situation,"  but  no  one  ever  did  gain  that  knowledge. 


104  Sir  William  Osler,  Bart. 

Osier's  habits  of  work,  wMle  lie  resided  at  The  Johns  Hop- 
kins Hospital,  were  exemplary  and  somewhat  "unusual  for  a 
man  of  literary  taste.  Such  men  are  usually  inclined  to  turn 
night  into  day.  but  he  rose  promptly  at  7  a.  m.,  took  his  bath 
and  breakfast  and  was  ready  for  work  at  8  o^ clock.  He  seemed 
to  have  a  faculty  for  setting  his  mental  machinery  in  motion 
immediately  and  accompKshed  effective  work  without  delay. 
When  his  secretary-  came  he  generally  began  to  dictate  and  by 
practice  acquired  great  facility  in  terse  and  vigorous  expres- 
sion. This  quality  also  was  undoubtedly  assisted  by  his 
famiharit}"  with  King  James'  version  of  the  Bible,  the 
Prayer  Book,  and  Sir  Thomas  Browne.  His  method  of  the 
preparation  of  the  Principles  of  Medicine  was  worthy  of 
being  followed  by  other  writers.  He  gathered  the  literature 
of  any  subject  which  he  had  on  hand  by  judicious  foraging  in 
his  library  and  elsewhere.  The  volumes  thus  collected  were 
piled  four  square  generally,  open  at  the  page  to  be  consulted 
upon  the  table,  as  long  as  room  sufficed  and  later  upon  the 
floor  until  movement  about  the  room  was  much  restricted.  I 
remember  that  when  after  seven  months  of  strenuous  labor 
he  completed  the  first  draft  of  his  treatise  on  medicine  I 
chanced  to  look  into  his  room  and  found  that  it  contained  an 
immense  heap  of  books  piled  as  high  as  the  table  like  an 
ancient  sacrificial  altar.  The  first  draft  was  carefully  revised 
with  no  great  amount  of  change  in  sentences  and  forms  of 
expression.  Such  changes  as  were  made,  however,  did  not 
destroy  the  crisp,  breezy  style  or  the  epigrammatic  form  of 
expression  which  has  always  been  characteristic  of  his  literary 
work.  The  book  contained  many  personal  references  which 
gave  peculiar  satisfaction  to  his  friends  by  reason  of  the  good- 
natured  personal  touches  he  frequently  gave  to  the  cherished 
beliefs  and  traditions  which  he  did  not  share.  I  remember 
in  speaking  of  the  use  of  turpentine  in  typhoid  fever,  he  said, 
"  The  routine  administration  of  turpentine  in  typhoid  fever 
is  a  useless  practice  for  the  perpetuation  of  which,  in  this 
generation,  H.  C.  Wood  is  largely  responsible."  This  some- 
what pointed  condemnation  of  a  generally  recognized  method 


Early  Eeminiscences  105 

of  treatment  at  that  time  brought  forth  a  vigorous  rejoinder 
from  Dr.  Wood  in  a  medical  journal,  but  fortunately  there 
was  no  loss  of  friendship  on  the  part  of  either  Osier  or  Wood. 

Osier  was  also  very  scrupulous  in  fulfilling  his  duties  in 
attendance  upon  the  meetings  of  medical  societies.  When 
once  informed  by  a  student  that  he  did  not  attend  the  meeting 
of  a  medical  society  because  he  was  not  sure  that  he  could  get 
anything  out  of  it  he  replied,  "  Do  you  think  I  go  for  what 
I  can  get  out  of  it  or  for  what  I  can  put  into  it  ?  '^  Those  who 
knew  him  felt  a  deep  impression  that  in  all  activities  in 
medical  societies  and  in  behalf  of  his  students  he  labored  solely 
to  inspire  them  with  a  love  of  work  for  its  own  sake  and  for 
what  he  felt  to  be  its  final  effect  upon  their  growth  and 
development. 

This  fact  was  brought  out  in  his  relations  to  the  Training 
School  for  Nurses,  established  at  the  hospital  in  October,  1889, 
which  were  of  an  ideal  character.  He  had  a  warm  friendship 
for  Miss  Hampton,  the  organizer  of  the  school  and  its  first 
principal,  and  also  for  Miss  Nutting,  her  successor.  He  gave 
much  assistance  in  the  way  of  advice  and  in  teaching  and  was 
warmly  interested  in  its  success.  He  gave  two  graduating 
addresses  also,  one  entitled,  "  Nurse  and  Patient,'^  and  the 
other,  "  Doctor  and  Nurse."  He  was  appreciative  of  the  work 
of  nurses  and  touched  lightly  and  gracefully  upon  the  mutual 
relations  of  the  nurse  to  her  co-worker,  the  doctor,  and  to  the 
object  of  her  care,  the  patient.  There  was,  however,  a  sus- 
picion of  an  attitude  of  reserve  towards  trained  nurses  as  a 
class  as  may  be  inferred  by  the  quotations  which  preceded 
these  addresses  when  published.  One,  for  example,  had  this 
significant  motto,  from  the  Psalms  of  David,  "  I  said  I  will 
take  heed  to  my  ways  that  I  offend  not  in  my  tongue.  I  will 
keep  my  mouth  as  it  were  with  a  bridle."  The  other  quotation 
was  from  Sir  Thomas  Browne,  "  Think  not  silence  the  wisdom 
of  fools,  but  if  rightly  timed  the  honor  of  wise  men  who  have 
not  the  infirmity,  but  the  virtue,  of  taciturnity  and  speak  not 
out  of  the  abundance,  but  the  well-weighed  thoughts  of  their 


106  Sir  William  Osler,  Bart. 

hearts.    Such  silence  may  be  eloquence  and  speak  thy  worth 
above  the  power  of  words." 

Osier  in  fact  seemed  always  appreciative  and  helpful  while 
at  the  same  time  he  had  an  air  of  detachment  as  one  who  was 
endeavoring  to  see  whither  the  movement  for  the  education  of 
nurses  would  ultimately  lead.  In  the  end  I  am  sure  that  he 
learned  to  understand  and  appreciate  the  work  of  the  training 
school  and  felt  the  great  importance  ©f  it  to  physicians  and  to 
the  advance  of  the  science  of  medicine. 


OSLER  AS  I  KNEW  HIM  IN  PHILADELPHIA  AND 
IN  THE  HOPKINS 

By  Howard  A.  Kelly 

I  find  myself  wondering,  in  these  days  of  pleasant  retro- 
spection, now  that  our  much  loved  friend  Sir  William  Osier 
is  so  splendidly  rounding  out  his  seventh  decade,  whether,  of 
all  his  friends  here,  I  may  not  claim  the  credit  of  having 
known  him  first. 

I  was  living  in  Philadelphia  up  in  the  big  mill  district  of 
Kensington,  culling  a  surgical  out  of  a  large  general  practice, 
and  at  the  same  time  keeping  in  close  touch  with  things  at  the 
University  of  Pennsylvania,  for  eight  years  my  college,  when 
it  became  manifest  that  some  fresh  and  stirring  blood  had 
entered  the  college  life. 

The  university,  with  so  many  eminent  men  camping  on  her 
very  doorstep  in  Philadelphia,  and  with  that  tendency  to 
nepotism,  a  form  of  paternal  pride  seen  in  all  successful 
institutions,  had,  as  we  younger  men  thought,  driven  John 
Guiteras  of  brilliant  promise  in  general  medicine,  away  from 
her  doors  to  protect  Pepper  from  rivalry,  and  now,  not  without 
great  hesitation  as  we  understood,  she  had  actually  broken 
her  shackles,  thrown  traditions  to  the  winds  and  pulled 
William  Osier  down  from  McGill  in  Montreal. 

Fresh  invigorating  currents  of  life  and  new  activities  in  our 
stereotyped  medical  teachings  began  at  once  to  manifest  them- 
selves, and  every  sturdy  expectant  youngster  in  short  order 
lined  himself  up  as  a  satellite  to  the  new  star.  Osier  breezes 
were  felt  everywhere  in  the  old  conservative  medical  center, 
and  yet  it  was  not  without  some  difficulties  that  he  securely 
established  himself.  Weir  Mitchell,  who  had  reason  in  his 
later  days  to  cultivate  kindlier  feelings  towards  the  university 
than  in  his  young  manhood,  was  from  the  first  Osier's  devoted 
and  intimate  friend,  and  one  by  one  the  faculty  was  won  to 

107 


108  Sir  William  Osler,  Bart. 


appreciate  him,  perhaps  including  even  Pepper  too,  though  I 
am  not  so  sure.  My  own  life  touched  Osier's  in  the  Kensing- 
ton mill  district  in  northeast  Philadelphia.  Aside  from 
anatomy  and  chemistry,  I  got  most  of  my  real  medical  educa- 
tion while  a  resident  in  the  Episcopal  Hospital  and  next  in 
the  homes  of  the  Kensington  folk.  Wood's  physiological 
therapeutics  and  Stille's  didactic  lectures  on  medicine  seemed 
deadly  to  me,  and  worst  of  all  was  Tyson's  pathology  elucidated 
by  Formad's  quizzes.  So  it  remained  to  get  the  education  at 
the  bedside,  and  here  Osier  came  to  my  aid.  It  was  more  than 
a  Sabbath  day's  journey  in  those  days  to  go  to  Kensington 
from  the  heart  of  the  city;  it  was  an  hour  in  the  street  car, 
and  a  long  drive  over  bad,  very  bad,  Philadelphia  streets,  but 
Osier  came  and  Agnew  came  with  their  lamps  in  their  hands 
to  illuminate  a  few  of  the  problems  in  the  vast  domain  in  which 
all  medical  graduates  are  presumed  to  be  exj)erts. 

I  think  the  first  patient  that  Osier  saw  was  suffering  from 
anorexia  nervosa,  a  condition  which  I  had  never  seen  before, 
and  of  which  I  was  ignorant.  He  stayed  to  dine  in  Morris 
Square,  and  was  particularly  interested  in  my  collection  of 
old  medical  books. 

Then  he  was  whisked  awa}^  to  Baltimore,  and  then  after  a 
yearns  time,  I  followed  at  his  behest,  glad  to  have  a  more 
concentrated  field  of  work. 

Here  I  can  add  nothing,  for  his  record  is  known  and  read 
of  all  men,  and  what  a  blessing  he,  and  Welch,  and  Halsted, 
and  Hurd  proved  to  be  in  this  community.  I  leave  others  to 
appreciate  Osier's  skill  as  a  medical  man,  and  his  love  of  the 
classics.  I  always  think  of  him  first  of  all  as  one  who  brought 
order  out  of  the  chaos  in  the  medical  profession  of  this  city,  a 
great  task  effected  by  his  kindly  personality,  his  insight  into 
human  nature,  and  the  genuine  affection  he  ever  felt  for  all 
men  who  were  even  half  way  good. 

It  was  a  settled  poHcy  of  Osier's  life  never  to  speak  ill  of 
any  one  but  always  to  find  the  good,  and  in  that  way  he  con- 
verted the  hostile  camp  of  Baltimore  into  a  kindly  family  of 
cooperating  doctors. 


In  Philadelphia  109 

Medicine  here  had  fangs  in  the  old  days.  Osier  and  Welch 
more  than  any  others  drew  them ;  and  so  made  possible  medical 
progress. 

I  want  to  lay  claim  to  the  gift  of  prophetic  insight  (a  role 
I  doubt  not  in  which  many  of  my  colleagues  have  anticipated 
me)  ;  I  had  said  from  the  first  that  Osier  was  bound  for 
London,  and  in  the  old  days  I  longed  to  be  ready  to  go  with 
him  when  he  went.  The  outcome  has  exceeded,  I  think,  all  our 
anticipations,  and  who  but  he  would  have  maintained  unabated 
the  same  interest  in  all  his  old  friends,  and  who  else  could 
have  turned  the  ocean  into  a  highway,  and  his  new  position, 
detached  as  it  is  from  any  vast  clinical  facilities,  into  a  veri- 
table medical  Mecca  for  all  our  American  medical  world.  That 
many  lustra  may  still  be  added  to  the  kindly  years  of  Lady  and 
Sir  William  Osier  is  the  wish  of  many  hearts. 


OSLER  AS  A  BIBLIOPHILE 
By  Thomas  E.  Boggs 

Adequate  treatment  of  this  important  side  of  Dr.  Osier's 
activities  would  far  transcend  the  present  writer's  abilities  and 
the  space  allotted  to  this  article.  But  it  may  be  of  some  value 
to  discuss  briefly  Dr.  Osier's  interest  in  old  books  as  reflected 
in  his  informal  talks  with  the  students. 

In  looking  back  it  seems  to  the  writer  that  the  interest  in 
the  early  editions  was  a  development  of  the  fundamental  value- 
he  placed  in  the  study  of  the  history  and  evolution  of  the 
science  and  art  of  medicine,  and  that  it  was  in  connection  with 
his  studies  of  the  fathers  of  medicine  in  all  times  and  countries 
that  he  began  that  collection  of  first  and  rare  editions  which 
has  now  reached  such  remarkable  proportions. 

When  the  plan  of  collecting  the  works  of  the  founders  of 
British  Medicine  was  first  originated  is  unknown  to  the  writer, 
but  it  had  already  reached  a  large  degree  of  perfection  at  the 
time  when  the  class  of  1901  began  to  make  the  Saturday  even- 
ing visits  to  the  old  house  at  No.  1  West  Franklin  Street. 

Most  of  us  will  ever  retain  the  delightful  recollection  of 
those  informal  gatherings  about  the  big  table  in  the  dining- 
room,  when  after  the  discussion  of  the  week's  work  in  the 
wards  was  finished,  "  the  chief  "  would  bring  out  some  of  the 
books  from  the  special  shelves  devoted  to  the  masters  of 
medicine  and  show  us  the  first  editions,  tell  us  the  story  of 
their  discovery  and  acquisition,  point  out  the  notable  passages, 
and  give  the  salient  facts  in  the  author's  life  history.  For 
many  of  us  this  was  the  beginning  of  our  knowledge  of  the 
history  of  medicine  and  of  our  own  feeble  attempts  to  follow 
in  his  steps  as  collectors. 

How  reverently  we  handled  and  admired  the  rare  little 
volumes,  of  Linacre's  grammar,  or  the  spurious  first  edition 
of  the  Eeligio,  or  Digby's  Animadversions,  with  their  choice 

8  111 


112  Sir  William  Oslee,  Bart. 

bindings  hj  Eiviere  or  Zaehnsdorff.  How  thrilled  by  the  story 
of  the  discovery  of  snch  a  treasure  on  a  York  bookstall,  boimd 
in  with  an  Almanack  and  bought  for  half  a  crown.  With  what 
delight  we  turned  the  pages  of  the  tall  copy  of  the  Pseudoxia 
Epidemica  and  dipped  into  the  grave  Sir  Thomases  discussion 
of  the  verity  of  the  pictures  of  God,  or  the  popular  idea  "  that 
elephants  have  no  knees."  A  beautiful  Aldine  from  Mead's 
own  library  brought  out  the  story  of  that  great  collector  and 
his  testamentary  instruction  that  his  library  be  sold  so  that 
others  might  have  some  of  the  pleasures  of  acquisition  which 
he  had  so  much  enjoyed.  We  were  given  a  glimpse  into  the 
special  lore  of  the  bibliophile,  and  learned  something  of  the 
work  of  the  pioneer  printers  and  of  the  great  presses  of  a  later 
date.  We  learned  a  little  of  the  fonts  of  type  and  the  water- 
marks of  papers,  as  well  as  the  characteristics  of  the  bindings 
peculiar  to  certain  periods.  The  nature  of  book  auctions  was 
disclosed  to  us  and  we  became  familiar  with  the  magic  names 
of  Sotheby  and  Quaritch,  until  some  of  us  found  the  perusal 
of  a  good  catalogue  as  exciting  as  a  detective  story.  Still  more 
important,  we  heard  about  the  more  famous  collections  of 
medical  works,  and  began  to  project  personal  visits  to  the 
Bodleian,  the  Eoyal  College  of  Physicians  and  the  Bibliotheque 
Rationale. 

But  best  of  all  and  doubtless  the  ultimate  object  of  all  was 
the  gradual  acquisition  of  an  epitome  of  the  history  of  medi- 
cine which  has  kept  us  interested  ever  since  those  days. 

Moreover,  it  was  not  merely  the  cultural  value  of  a  knowl- 
edge of  the  beginnings  of  the  profession,  but  the  constant 
lesson  of  the  individual  worker's  triumph  over  handicaps  of 
isolation,  poverty,  ridicule  or  personal  peril,  to  add  some  con- 
tribution to  the  sum  of  knowledge,  and  the  reiteration  of  the 
theme  that  the  painstaking  and  observant  physician,  even 
though  removed  from  the  centers  of  learning  and  wide  oppor- 
tunity, has  in  the  past  contributed  fundamentally  to  the 
advancement  of  knowledge,  and  may  hope  to  do  so  in  th^ 
future. 


As  A  Bibliophile  113 

Again,  Dr.  Osier  stimulated  in  us  an  interest  in  the  medical 
writers  of  the  early  days  of  our  own  country  and  showed  how 
much  might  be  found  by  the  investigation  of  the  early  journals 
and  books,  and  this  has  led  to  the  substantial  contributions  by 
his  associates  and  pupils  to  the  history  of  medicine  in  the 
colonies,  the  United  States  and  Canada. 

In  conclusion,  another  side  of  Dr.  Osier's  bibliophilic 
activity  must  be  noted,  that  is,  his  generous  interest  in  the 
medical  libraries  of  the  country.  He  was  not  satisfied  to 
acquire  rare  and  interesting  volumes  for  himself,  but  was 
constantly  giving  such  books  to  the  various  professional 
libraries  with  which  he  had  been  associated;  thus,  McGill, 
Boston,  The  College  of  Physicians  in  Philadelphia  and  our 
own  Maryland  Faculty  and  Johns  Hopkins  have  repeatedly 
received  valuable  acquisitions  from  him  or  from  others  whom 
he  had  induced  to  give  rare  volumes  or  even  whole  collections. 

We  are  happy  to  know  how  vastly  "  the  chiefs ''  collection 
has  grown  since  he  removed  to  the  University  of  Oxford,  so 
that  it  is  now  one  of  the  very  best  in  existence.  The  catalogue, 
bibliographic,  biographic  and  literary,  of  this  great  collection 
of  the  epoch-making  works  of  science  occupies  most  of  his 
leisure,  and  will  form  another  great  contribution  to  the 
literature  of  medicine,  second  only  to  the  immortal  Practice. 


OSLER^S  LITEEARY  STYLE 
By  Edward  N.  Brush 

There  are  in  connection  with  the  task  which  has  been 
assigned  to  me  many  very  pleasant  aspects.  To  make  a  critical 
analysis,  to  present  a  clear  picture  of  Dr.  Osier's  literary  style 
demands,  however,  more  time  and  space  than  are  at  my  dis- 
posal and  above  all  more  ability  as  a  literary  critic  than  I  am 
endowed  with. 

In  reading  Dr.  Osier's  contributions  to  the  literature  of 
medicine,  as  well  as  his  occasional  addresses  and  essays,  I  am 
tempted  to  linger  here  and  there,  to  point  out  the  clarity  of 
expression,  the  simplicity  and  beauty  of  diction  and  quote 
passage  after  passage  in  illustration  of  my  thesis.  Such  a 
course  would  simplify  the  task  before  me  because  these  quota- 
tions would  show  the  author's  style  better  than  any  powers  of 
description  or  any  ability  of  analysis  I  possess. 

In  his  purely  scientific  work,  as  for  example,  in  The 
Principles  and  Practice  of  Medicine,  the  author's  method  and 
his  grasp  of  his  subject  are  admirable.  He  follows  the  advice 
of  the  friend  of  Cervantes  when  the  author  of  Don  Quixote 
was  in  a  quandary  over  the  preparation  of  his  preface, 
"  Nothing  but  pure  nature  is  your  business ;  her  you  must 
consult,  and  the  closer  you  can  imitate,  your  picture  is  the 
better." 

In  my  student  days  some  one  placed  in  my  hands  a  cojDy 
of  Watson's  Practice.*  While  it  was  not  recommended  as  a 
text-book  to  follow  as  an  exponent  of  the  then  recognized 
principles  of  medical  thought  and  practice,  I  found  it  one  of 
the  easiest  works  to  read  and  one  from  which  I  obtained  much 
of  lasting  value.  Commenting  upon  this  fact  to  my  preceptor 
I  was  told  that  I  had  fallen  upon  a  book  which  possessed, 
something  not  common  in  medical  treatises,  a  good  style. 

*  Lectures  on  the  Principles  and  Practice  of  Phj^ic.  By  Thomas 
Watson,  M.  D.,  etc.,  London,  1843. 

115 


116  SiK  William  Osler,  Bart. 

The  same  is  true  of  Osier's  writings  upon  the  strictly 
scientific  aspect  of  medicine.  Unity,  order,  clarity  of  descrip- 
tion and  ease  of  diction  abound  throughout  his  text-book  and 
his  various  monographs.  A  master  of  his  subject,  having  made 
the  nature  of  disease  his  business,  he  imparts  his  information 
in  such  a  manner  that  the  reader  at  no  time  finds  it  difficult, 
because  of  ambiguous  phraseology  or  doubtful  expression,  to 
grasp  his  meaning.  His  thoughts  are  "  linked  with  the  wants 
of  his  readers,''  and  by  the  invisible  chains  which  bind  mind  to 
mind,  he  and  his  reader  become  one. 

The  reader  finds  that  he  has  a  message  to  impart,  a  principle 
to  establish,  a  rule  of  conduct  to  promulgate,  and  that  he  has 
done  so  in  a  logical,  attractive  maner  which  compels  attention ; 
and  that  to  my  mind  is  the  test  and  measure  of  good  writing. 

Another  view  of  Osier  as  an  author  is  revealed  in  his  occa- 
sional addresses  and  essays.  In  the  two  volumes  before  me — 
" Aequanimitas  and  Other  Addresses"  and  *^^ An  Alabama 
Student  and  Other  Biographical  Addresses  " — Osier's  style  in 
all  its  directness,  strength  and  grace  is  shown  in  full  measure. 

In  these  volumes,  as  in  other  addresses  not  therein  con- 
tained, notably  his  farewell  to  his  professional  associates  and 
friends  in  Maryland  under  the  title  "  Unity,  Peace  and  Con- 
cord," Osier  exemplifies  Buffon's  dictum:  "The  style  is  the 
man  himself." 

Sir  Thomas  Watson  in  his  memorial  of  Latham,  whose 
"Lectures  on  Clinical  Medicine"  are  examples  of  the  best 
English  style,  says :  "  His  letters  are  treasures  of  good  sense, 
of  lively  and  epigrammatic  comments  on  men  and  things  and 
of  shrewd  and  weighty  reflections,  wise  advice  and  affectionate 
greetings  " ;  and  this  can  be  with  great  truth  applied  to  the 
addresses  and  essays  of  Dr.  Osier.  Lively,  epigrammatic, 
shrewd,  weighty  and  affectionate  are  all  terms  which  well  suit 
my  purpose,  which  reveal  the  man  through  his  writing. 
"  Talent  alone  cannot  make  a  writer,"  says  Emerson,  "  there 
must  be  a  man  behind  the  book,  a  personality  which  by  birth 
and  quality  is  pledged  to  the  doctrines  there  set  forth." 


Literary  Style  117 

With  Byron  one  ^^  hates  an  author  that's  all  author/'  In 
Orsler's  case  the  author  is  all  man,  and  the  man  reflects  him- 
self in  his  work.  It  is  an  easy  task  for  those  who  have  had  the 
pleasure  and  advantage  of  intimate  association  with  him  to 
invoke  his  presence  when  reading  his  addresses,  as  for  example, 
"Internal  Medicine  as  a  Vocation,'^  "Medicine  in  the  Nine- 
teenth Century,"  "The  Hospital  as  a  College"  and  "The 
Master  Word  in  Medicine." 

What,  if  any,  are  the  secrets  of  Osler^s  style ;  upon  what  does 
it  depend?  The  answer,  I  think,  is  simply  a  love  for  and 
thorough  mastery  of  good  literature  and  a  message  to  convey 
full  of  high  ideals.  One  William  Harrison,  writing  in  1577, 
speaks  of  "  an  excellent  vein  of  writing  not  beforetime  re- 
garded" which  has  become  manifest  in  England.  This  he 
intimates  is  the  result  not  only  of  a  knowledge  on  the  part  of 
writers  of  their  own  tongue,  but  of  an  acquaintance  with  the 
Latin  and  Greek  and  often  with  French  and  Spanish. 

This  excellent  vein  of  writing  soon  became  the  glory  of  the 
Elizabethan  age.  The  development  of  higher  ideals  in  English 
national  life  was  rapidly  followed,  as  well  as  fostered,  by  the 
great  authors  of  the  age  of  England's  literary  glory.  Style, 
literary  excellence,  came  to  be  recognized  as  desirable,  and 
reached  its  highest  manifestation.  Back  of  it  all,  however,  were 
the  ideals  which  fostered  and  gave  material  for  the  expression 
of  literary  style.  There  was  an  atmosphere  of  a  great  elevation 
of  ideals,  public  and  private,  and  at  the  same  time  tangible 
objects  of  national  ambition  and  glory.  England  was  "  con- 
tending in  the  cause  of  the  world  as  well  as  her  own  "  and  there 
was  an  outburst  of  genius  which  found  its  counterpart  in  a 
smaller  degree  many  years  later  when  England  was  contending 
again  the  world-ambition  of  Napoleon. 

Will  a  similar  development  follow  the  world's  war  out  of 
which  we  are  just  emerging? 

When  a  man  who  has  ideals  and  honesty  of  purpose  and  has 
filled  his  mind  with  the  productions  of  the  master  spirits  of  the 
ages  feels  the  call  to  write  or  speak,  a  beauty  of  literary  style 
almost  inevitably  results. 


118  Sir  William  Oslee,  Bart. 

What  were  the  Pierian  springs  from  which  Osier  drank, 
from  which  he  attained,  as  has  been  said  of  him,  "  a  breadth  of 
learning  and  a  knowledge  of  general  literature  that  astound 
one?^' 

I  would  place  first  the  English  Bible.  How  often  either  by 
direct  quotation  or  paraphrase  does  one  find  in  his  addresses 
and  essays  sentences  and  phrases  from  this  well-spring  of  good 
English. 

Of  a  liberal  knowledge  of  the  classics  abundant  evidence  is 
found  and  a  ready  ability  to  take  text,  and  illustration  as  well, 
from  mythology. 

With  the  masters  of  the  English  tongue  from  the  early  dawn 
of  English  literature  till  the  present  he  has  clearly  dwelt  on 
terms  of  greatest  intimacy. 

That  half-hour  devoted  every  day  to  communion  with  the 
minds  of  the  past  finds  lessons  reflected  in  writing,  but  never 
with  any  indication  of  servile  cop3dng,    Osler^s  style  is  his  own. 

The  last  page  of  Aequanimitas  has  a  list  of  books  which 
Osier  has  called  a  Bed-side  Library  for  Medical  Students. 
This  is:  1.  Old  and  New  Testament;  2.  Shakespeare:  3. 
Montaigne;  4.  Plutarch's  Lives:  5.  Marcus  Aurehus:  6.  Epic- 
tetus;  7.  Eeligio  Medici;  8.  Don  Quixote;  9.  Emerson;  10. 
Oliver  Wendell  Holmes — Breakfast-Table  Series. 

John  Brown,  of  Edinburgh  (Horae  Subsecivae,  p.  -±00), 
gives  a  list  which  he  commends  to  the  medical  student.  These 
are  ^'  Shakespeare,  Cervantes,  Milton,  D'ryden,  Pope,  Cowper, 
Montaigne,  Addison,  Befoe  Goldsmith.  Fielding.  Scott.  Lamb, 
Macaulay,  Jeffrey,  Sydney  Smith,  Helps  and  Thackeray." 
Bro^Ti's  list  has  nearly  twice  as  many  names  as  that  given  by 
Osier,  but  in  solid  worth  the  shorter  list  outweighs  the  longer. 

Dr.  Osier's  list  fulfills  in  brief  compass  the  requirements  of 
a  liberal  education  and  presents  to  the  reader  examples  of  the 
best  in  literature. 

Eeference  has  already  been  made  to  the  fact  that  Dr.  Osier 
is  reflected  in  his  writings,  that  in  the  words  of  Taine  "  behind 
the  document  there  was  a  man." 


Literary  Style  119 

In  this  instance  that  man  had  for  years  exercised,  as  I  have 
tried  to  show  elsewhere,  a  singular  and  powerful  influence  on 
medical  education,  hospital  methods  and  in  binding  together 
for  harmonious  action  the  members  of  his  profession. 

lie  had  encouraged  the  study  of  medical  history  and  biog- 
raphy and  found  time  in  the  midst  of  duties,  which  might  well 
have  availed  as  an  excuse  from  further  intellectual  labors,  to 
contribute  in  large  measure  to  these  subjects. 

Always,  witli  no  false  note,  his  cry  has  been  for  scientific 
righteousness.  He  has  had  ideals  and,  as  an  idealist,  he  has 
done  what  he  has  himself  said  other  idealists  have  often  done, 
"  gradually  moulded  to  their  will  conditions  the  most  adverse 
and  hopeless.'' 

All  of  this  and  much  more  is  reflected  in  the  text  of  Osler'.^ 
writing,  presented  often  in  epigrammatic  form,  reinforced  by 
text  and  example  from  many  sources,  enlivened  by  a  humor 
that  is  irresistible. 

No  medical  contributor  to  general  literature  since  Holmes 
has  possessed  the  saving  sense  of  humor  to  the  degree  shown 
in  Osier's  writings  and  no  one  could  have  used  it  with  greater 
discrimination  or  more  certain  effect. 

Often  when  apparently  writing  in  a  most  humorous  vein  he 
has  been  the  most  serious  in  his  meaning,  and  how  often  and 
with  what  delicate  touch  does  he  expose  some  of  our  human 
faults  and  foibles.  I  yield  to  the  temptation  to  quote  here  an 
illustration  of  that  to  which  I  have  just  referred.  "  Curious, 
odd  compounds  are  these  fellow-creatures,  at  whose  mercy  you 
will  be ;  full  of  fads  and  eccentricities,  of  whims  and  fancies ; 
but  the  more  closely  we  study  their  little  foibles  of  one  sort 
and  another  in  the  inner  life  which  we  see,  the  more  surely  is 
the  conviction  borne  in  upon  us  of  the  likeness  of  their  weak- 
nesses to  our  own.  The  similarity  would  be  intolerable  if  a 
happy  egotism  did  not  often  render  us  forgetful  of  it.  Hence 
the  need  of  an  infinite  patience  and  an  ever-tender  charity 
toward  these  fellow  creatures;  have  they  not  to  exercise  the 
same  toward  us  ?  " 


120  Sir  William  Osler,  Bart. 

To  Osier's  style  may  be  applied  part  of  his  own  estimate  of 
some  of  the  older  writers,  Burton,  Browne  and  Fuller:  "A 
rare  quaintness,  a  love  of  odd  conceits  and  the  faculty  of  apt 
illustration." 

In  his  writings  he  reminds  us  of  what  he  has  said  of  Browne, 
"  The  charm  of  high  thoughts  clad  in  beautiful  language  may 
win  some  readers  to  a  love  of  good  literature ;  but  beyond  this 
is  a  still  greater  advantage  ....  the  Religio  is  full  of  the 
counsels  of  perfection." 

So,  too,  is  there  with  Osier  a  "  charm  of  high  thoughts  clad 
in  beautiful  language"  and  always  the  "counsels  of  perfec- 
tion." 

Osier's  literary  work  is  yet  unfinished,  the  three  score  years 
and  ten  which  he  has  attained  have  but  ripened  his  judgment 
and  enlarged  his  field  of  vision.  He  has  seen  many  of  his  ideals 
become  realities.  The  stress  of  the  great  world  war  has  pressed 
heavily  upon  him  and  brought  to  him  a  great  sorrow.  The 
iron  has  entered  into  his  soul.  His  future  work  will  bear  the 
stamp  of  all  these. 

He  has  made  his  own  estimate  of  the  "  princes  of  the  blood  " 
in  literature  from  our  profession.  He  places  Sir  Thomas 
Browne,  Holmes  and  John  Brown,  of  Edinburgh,  in  a  group 
high  in  the  circle. 

Osier  possesses  many  things  in  common  with  these  three  in 
literary  style  and  in  literary  excellence,  and  deserves  a  place 
in  the  same  exalted  fellowship. 


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BIBLIOGEAPHY 

OF 

SIR  WILLIAM  OSLER,  Bart.,  M.  D.,  F.  R.  S. 

compiled  by 

Minnie  Wright  Blogg 

librarian,  the  johns  hopkins  hospital 

Sir  William  Osier's  bibliography  covers  a  period  of  49  years 
(1870-1919).  The  773  titles  include  both  books  and  articles. 
Many  of  these  are  in  the  library  of  The  Johns  Hopkins  Hos- 
pital and  have  added  value  as  being  personal  gifts  from  the 
author. 

1870 

On  Canadian  diatomaceae.    Canad.  Naturalist,  Montreal,  1870,  n.  s., 
V,  142-151. 
In  his:  Published  Mem.  &  Communicat,  Montreal,  1882,  8". 
[Collect,  repr.,  1872-1882,  i,  no.  1.] 

1873 

Action  of  certain  reagents — atropia,  physostigma  and  curare — on 
the  colorless  blood-corpuscles.    Quart.  J.  Micr.  Sc,  Lond.,  1873, 
n.s.,  xiii,  307-309. 
In  his:  Published  Mem.  &  Communicat.,  Montreal,  1882,  8°. 
[Collect,  repr.,  1872-1882,  1,  no.  2.] 

1874 

An  account  of  certain   organisms  occurring  in  the  liquor  san- 
guinis.    FRep.  by  J.  B.  Sanderson.]     Proc.  Roy.  Soc,  Lond., 
1874,  xxii,  391-398. 
In  his:  Collect,  repr.,  1872-82,  i,  no.  3. 

1875 

Uterine  thermometry.  (Cohnstein,  Die  Thermometrie  des  Uterus.) 
Translated  from  Virchow's  Archiv,  Bd.  Ixii,  Heft  i.  Canada 
M.  &  S.  J.,  Montreal,  1874-5,  iii,  294-297. 

Valedictory  address  to  the  graduates  in  medicine  and  surgery, 
McGill  University.     Canada  M.  &  S.  J.,  Montreal,  1874-75,  iii, 
433-438. 
In  his:  Published  Mem.  &  Communicat.,  Montreal,  1882,  8^. 
[Collect,  repr.,  1872-82,  i,  no.  4.] 

121 


122  Sir  William  Osler^  Bart. 

1876 

Introductory  remarks  to,  and  synopsis  of,  practical  course  on 
institutes  of  medicine.  Canada  M.  &  S.  J.,  Montreal,  1875-76, 
iv,  202-207. 

Histological  characters  of  the  tumour,  [A  case  of  melano-sarcoma 
of  the  choroid,  by  A.  Proudfoot.]  Canada  M.  &  S.  J.,  Montreal, 
1875-76,  iv,  298-300. 

Histological  and  general  description  of  the  tumors.  [Case  of 
glioma  of  both  retinae.  Extirpation  of  both  eyes,  by  G.  B. 
Fenwick.]     Canada  M.  &  S.  J.,  Montreal,  1875-76,  iv,  306-308. 

Notice  of  the  recent  researches  on  the  pathology  of  small-pox. 
Canada  M.  &  S.  J.,  Montreal,  1875-76,  iv,  341-343. 

On  the  pathology  of  miner's  lung.     Canada  M.  &  S.  J.,  Montreal, 
1875-76,  iv,  145-168. 
In  his:  Collect,  repr.,  1872-82,  1,  no.  7. 

Case  of  scarlatina  miliaris.    Canada  M.  &  S.  J.,  Montreal,  1875-76, 
iv,  49-54. 
In  his:   Collect,  repr.,  1872-82,  i,  no.  5. 

On  the  histology  of  leucocythemia.    Canada  M.  &  S.  J.,  Montreal, 
1875-76,  iv,  439-477. 
In  his:  Collect,  repr.,  1872-82,  i,  no.  6. 

Clinical  notes  on  small-pox.     I.  The  initial  rashe^.     II.  Haemor- 
rhagic   small-pox.     III.   A   form   of   hsemorrhagic   small-pox. 
Montreal,  1876.    Gazette  P't'g  House,  35  p.,  8°. 
Also:  Canada  M.  &  S.  J.,  Montreal,  1876-77,  v,  241;  289. 
In  his:   Published  Mem.  &  Communicat.,  Montreal,  1882. 
[Collect,  repr.,  1872-82,  i,  nos.  8,  9,  10.] 

Trichina  spiralis.  Extract  from  a  lecture  on  "  Animal  parasites 
and  their  relation  to  public  health,"  being  one  of  the  Somer- 
ville  lectures  of  the  Natural  History  Society.  Canad.  J.  M.  Sc, 
Toronto,  1876,  i,  134-135. 

1877 

Introductory  lecture  on  the  opening  of  the  forty-fifth  session  of  the 
medical  faculty,  McGill  University,  Oct.   1,  1877.     Montreal, 
1877,  Dawson  Bros.,  19  p.,  8°. 
Also:  Canada  M.  &  S.  J.,  Montreal,  1877-78,  vi,  193-210. 
In  his:  Published  Mem.  &  Communicat.,  Montreal,  1882,  8°. 
[Collecl.  repr.    1872-82,  i,  no.  14.] 

Post-mortem,  eleven  hours  after  death.  [Case  of  cerebral  aneur- 
ism, by  J.  Bell.]    Canada  M.  &  S.  J.,  Montreal,  1876-77,  v,  57-58. 

Verminous  bronchitis  in  dogs;  read  before  the  Montreal  Veterinary 
Medical  Association,  March  29.     Veterinarian,  Lond.,  1877,  i, 
387-397. 
In  his:  Published  Mem.  &  Communicat,  Montreal,  1882,  8°. 
[Collect,  repr.,  1872-82,  i,  no.  12.] 

Beschaffenheit   des   Blutes   und   Knochenmarkes   bei   pernicioser 
Anamie.    Centralbl.  f.  d.  med.  Wissensch.,  Berl.,  1877,  xv,  498. 
Ih  his:  Published  Mem.  &  Communicat.,  Montreal,  1882,  8°. 
[Collect,  repr.,  1872-82,  i,  no.  18.] 


Bibliography  123 

Osier,  W.,  and  Bell,  J.:    Case  of  progressive  pernicious  anaemia. 
Clinical  report,  by  John  Bell.     Pathological  report,  with  re- 
marks,  by  William   Osier.     Montreal,   1877,  Lovell  Print.   & 
Publ.  Co.,  12  p.,  12^ 
In  Ms:  Collect,  repr.,  1872-82,  i,  no.  16. 

Osier,  W.,  and  Gardner,  W. :   Case  of  progressive  pernicious  anaemia 
(idiopathic  of  Addison).    Canada  M.  &  S.  J.,  Montreal,  1876-77, 
V,  385-404. 
In  his:  Collect,  repr.,  1872-82,  i,  no.  15. 

Osier,  W.,  and  Gardner,  W.:    Ueber  die  Beschaffenheit  des  Blutes 
und  Knochenmarkes  in  der  progressiven  perniciosen  Anamie. 
Centralbl.  f.  d.  med.  Wissensch.,  Berl.,  1877,  xv,  258-260. 
In  his:   Published  Mem.  &  Communicat.,  Montreal,  1882,  8^. 
[Collect,  repr.,  1872-82,  i,  no.  17. J 

1878 

On  the  pathology  of  the  so-called  pig-typhoid.    London,  1878,  Bail- 
li^re,  Tindall  &  Cox,  20  p.,  8°. 
Vet.  J.  &  Ann.  Comp.  Path.,  Lond.,  1878,  vi,  385-402. 
In  his:   Published  Mem.  &  Communicat.,  Montreal,  1882. 
[Collect,  repr.,  1872-82,  i,  no.  20.J 

Over-strain  of  the  heart,  as  illustrated  by  a  case  of  hypertrophy, 
dilatation  and  fatty  degeneration  of  the  heart,  consequent 
upon  prolonged  muscular  exertion.  Montreal,  1878,  Gazette 
P't'g  House,  13  p.    S\ 

Also:   Canada  M.  &  S.  J.,  Montreal,  1877-78,  vi,  385-395. 

In  his:  Published  Mem.  &  Communicat.,  Montreal,  1882,  8'. 

[Collect,  repr.,  1872-82,  i,  no.  19.] 

Phthisical   cavities  in  left  lung;    gangrene  of  pulmonary  tissue 
about  one  of  them.    Canada  M.  &  S.  J.,  Montreal,  1877-78,  vi, 
114. 
Also:  Montreal  Gen.  Hosp.  Rep.  (1876-77),  1878,  i,  37. 

Pleura.     Small  fibroid  thickenings  on  visceral  layer.     Canada  M. 
&  S.  J.,  Montreal,  1877-78,  vi,  115-116. 
Also:  Montreal  Gen.  Hosp.  Rep.  (1876-77),  1878,  i,  40-41. 

Fracture  of  Ist  and  2d  ribs  near  vertebrae,  from  direct  violence; 
deep  abscess  of  the  neck;  obliteration  of  subclavian  artery; 
empyema.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i, 
11-12. 

Necrosis  of  tibia.  Ulcerative  endocarditis,  pyaemic  pneumonia. 
Montreal  Gen.  Hosp.  Path.  Rep.   (1876-77),  1878,  i,  12-13. 

Necrosis  of  femur,  pyaemic  pneumonia;  abscesses  in  superficial 
muscles;  pustular  eruption  on  skin.  Montreal  Gen.  Hosp. 
Path.  Rep.  (1876-77),  1878,  i,  13-14. 

Primary  cancer  of  bodies  of  2d  and  3d  vertebrae  and  heads  of 
corresponding  ribs  on  right  side.  Secondary  masses  in  ribs, 
liver  and  brain.  Chronic  phthisis.  Lobar  pneumonia.  Mon- 
treal Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i,  14-16. 

A  case  of  hypertrophy  and  dilatation  of  the  heart;  no  valvular  or 
arterial  disease;  no  chronic  kidney  affection;  hydrothorax; 
pulmonary  apoplexy;  general  venous  stasis.  Montreal  Gen. 
Hosp.  Path.  Rep.  (1876-77),  1878,  i,  16-20. 


124  Sir  William  Osler,  Baet. 

Aneurism  of  comnLencement  of  thoracic  aorta,  unsuspected  during 
life;  death,  from  general  tuberculosis.  Montreal  Gen.  Hosp. 
Path.  Rep.  (1876-77),  1878,  i,  20-21. 

Sacculated  aneurism  of  ascending  portion  of  arch  of  aorta;  rup- 
ture into  the  right  pleural  sac.  Montreal  Gen.  Hosp.  Path. 
Rep.  (1876-77),  1878,  i,  21. 

Sacculated  aneurism  of  aorta,  at  termination  of  the  arch,  un- 
suspected during  life.  Death  from  pneumonia.  Montreal  Gen. 
Hosp.  Path.  Rep.  (1876-77),  1878,  i,  22. 

Aneurism  of  hepatic  artery.  Right  branch  almost  obliterated. 
Multiple  abscesses  in  the  liver.  Montreal  Gen.  Hosp.  Path. 
Rep.  (1876-77),  1878,  i,  22-30. 

Aneurismal  dilatation  of  branches  of  pulmonary  artery  on  the 
walls  of  phthisical  cavities.  Death  from  haemoptysis.  Mon- 
treal Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i,  30. 

Aneurism  at  second  bifurcation  of  the  right  middle  cerebral 
artery;  rupture;  extravasation  of  blood  into  the  Sylvian  fis- 
sure, and  laceration  of  substance  of  the  temporosphenoidal 
lobe,  death  in  36  hours.  Montreal  Gen.  Hosp.  Path.  Rep. 
(1876-77),  1878,  i,  30-32. 

Ossification  of  greater  portion  of  mucous  membrane  of  trachea. 
Montreal  Gen.  Hosp.  Path.  Rep.   (1876-77),  1878,  i,  32. 

Pneumonia  of  the  upper  lobe  of  the  right  lung;  extensive  menin- 
geal inflammation.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77), 
1878,  i,  33-34. 

Almost  entire  hepatization  of  left  lung;  with  small  pneumonic 
area  in  right.  Extensive  diphtheritic  colitis.  Montreal  Gen. 
Hosp.  Path.  Rep.  (1876-77),  1878,  i,  34. 

Diabetes,  phthisical  cavity  in  right  lung  surrounded  by  hepatized 
tissue.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i, 
34-35. 

Chronic  phthisis,  almost  entire  destruction  of  both  lungs.  Healthy 
portion  involved  in  a  pneumonia.  Montreal  Gen.  Hosp.  Path. 
Rep.  (1876-77),  1878,  i,  35. 

Simple  pneumonia  of  left  lung,  right-side,d  pleurisy.  Montreal 
Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i,  35. 

Pneumonia  of  right  lung,  uniform  involvement  of  pleura  covering 
it.    Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i,  35-37. 

Fibroid  contraction  and  induration  of  entire  right  lung;  cavity  at 
apex;  displacement  of  heart;  hypertrophy  with  dilatation  of 
right  chambers.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77), 
1878,  i,  38-39. 

Chronic  phthisis;  perforation  of  lungs;  pneumothorax;  dermoid 
cyst  of  right  ovary.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77), 
1878,  i,  39-40. 

Epithelioma  of  right  side  of  tongue,  extending  from  base  to  near 
the  apex.  Removal  of  organ  with  galvanic  ecraseur.  Suppura- 
tion beneath  cervical  fascia.  Pysemia.  Montreal  Gen.  Hosp. 
Path.  Rep.  (1876-77),  1878,  i,  41-42. 


Bibliography  125 


Chronic  phthisis.  Miliary  tubercles  in  lungs  and  pharynx.  Mon- 
treal Gen.  Hosp.  Path.  Rep.   (1876-77),  1878,  i,  42-43. 

Cancer  of  the  cardiac  orifice,  involving  the  oesophagus.  Secondary 
masses  in  other  parts  of  the  organ.  Montreal  Gen.  Hosp.  Path. 
Rep.  (1876-77),  1878,  i,  43-44. 

Medullary  cancer,  involving  the  pyloric  zone  of  the  stomach; 
perforation,  peritonitis.  Montreal  Gen,  Hosp.  Path.  Rep. 
(1876-77),  1878,  i,  44. 

Passage  of  two  feet  of  the  ileum  through  a  loop  attached  to  the 
sigmoid  flexure.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77), 
1878,  i,  45. 

Round  ulcer  of  duodenum.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876- 
77),  1878,  i,  45-46. 

Perforation  of  typhoid  ulcer  during  convalescence,  owing  to  an 
indiscretion  in  diet.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876- 
77),  1878,  i,  46. 

Perforation  of  a  deep  ulcer  at  end  of  second  week.  Montreal  Gen. 
Hosp.  Path.  Rep.  (1876-77),  187^  i,  46-47. 

Typhoid  fever.  Perforation.  Peritonitis.  Montreal  Gen.  Hosp. 
Path.  Rep.  (1876-77),  1878,  i,  47. 

Four  round  ulcers  in  the  ileum.  Peyer's  patches  not  generally  in- 
volved. Slight  hypostatic  pneumonia.  Montreal  Gen.  Hosp. 
Path.  Rep.   (1876-77),  1878,  i,  48. 

Slight  swelling  of  Peyer's  glands,  only  one  small  spot  of  ulceration. 
Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i,  48. 

Round  ulcer  of  caecum,  perforation,  general  peritonitis.  Montreal 
Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  1,  49. 

Abscesses  in  the  mesentery.  Suppuration  of  portal  vein.  Empyema. 
Perforation  of  appendix,  general  peritonitis.  Montreal  Gen. 
Hosp.  Path.  Rep.  (1876-77),  1878,  i,  51. 

Acute  tubercular  inflammation  of  the  peritoneum.  Small  caseous 
mass  in  left  lung.  Right-sided  pleurisy.  General  hyperplasia 
of  the  bone  marrow.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876- 
77),  1878,  i,  52-56. 

Cirrhosis  of  liver,  with  enlargement;  jaundice;  no  ascites;  delir- 
ium tremens  (?) :  erysipelas  of  the  head.    Montreal  Gen.  Hosp. 
Path.  Rep.  (1876-77),  1878,  i,  56-60. 
Also:   Canada  M.  &  S.  J.,  Montreal,  1877-78,  vi,  249-253. 

Syphilitic  ulceration  of  left  frontal  bone;  large  node  on  left  tibia; 
gummata  in  liver.    Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77), 
1878,  i,  60-61. 
Also:  Canada  M.  &  S.  J.,  Montreal,  1877-78,  vi,  253. 

Primary  cancer  of  the  liver;  ascites;  jaundice;  secondary  mass  in 
tail  of  pancreas;  small  se,condary  nodules  in  kidneys.    Mon- 
treal Gen.  Hosp.  Path.  Rep.   (1876-77),  1878,  i,  61-64. 
Also:  Canada  M.  &  S.  J.,  Montreal,  1877-78,  vi,  254-256. 


126  Sir  William  Osler,  Bart. 

Cancer  of  neck  of  the  gall-bladder  and  lymphatic  glands  in  the 
portal  fissure;  compression  of  the  hepatic  ducts;  secondary- 
masses  in  liver;  enormous  distension  of  gall-bladder,  and 
haemorrhage  into  it;  gall-stones.  Montreal  Gen.  Hosp.  Path. 
Rep.   (1876-77),  1878,  i,  64-65. 

Extensive  abscesses  in  the  mesentery,  following  typhoid  fever. 
Suppuration  of  the  portal  vein  and  its  branches  in  the  liver. 
Empyema.  Perforation  of  the  appendix  vermiformis;  peri- 
tonitis; miliary  tubercles  in  lungs.  Amyloid  degeneration  of 
spleen,  liver,  and  mucous  membrane  of  small  intestine.  Mon- 
treal Gen.  Hosp.  Path.  Rep.   (1876-77),  1878,  i,  65-71. 

Tuberculous  disease  of  right  kidney,  pelvis,  ureter  and  bladder. 
Tubercles  in  left  kidney  and  lungs.  Perforation  of  tuberculous 
ulcer  in  bladder.  Peritonitis.  Montreal  Gen.  Hosp.  Path.  Rep. 
(1876-77),  1878,  i,  72-73. 

Old  scrofulous  disease  of  right  kidney,  which  is  converted  into 
cysts.  Recent  affection  of  the  left.  Montreal  Gen.  Hosp.  Path. 
Rep.  (1876-77),  1878,  i,  73-74. 

Old  disease  of  the  right  kidney,  which  is  converted  into  five  or  six 
cysts,  filled  with  a  putty-like  material.  Extensive  tuberculous 
disease  of  the  organ.  Miliary  tubercles  in  lungs.  Albuminoid 
spleen.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i, 
74-75. 

Suppuration  about  right  kidney.  Pysemic  abscesses  in  elbows, 
ankles  and  anterior  mediastinum.  Peritonitis.  Pleurisy. 
Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i,  75-76. 

Stone  in  the  bladder.  Prostatic  tumors  around  the  urethral  orifice. 
Ulceration  on  mucous  membrane.  Pyelitis;  ulceration  of 
apices  of  renal  pyramids.     Montreal  Gen.  Hosp.  Path.  Rep. 

(1876-77),  1878,  i,  76-77. 

Epithelioma  of  cervix;  obstruction  of  the  canal;  dilatation  of  the 
uterine  cavity.     Pyometra.     Montreal  Gen.  Hosp.  Path.  Rep. 

(1876-77),  1878,  i,  77-78. 

Dermoid  or  piliferous  cyst  of  right  ovary.  Chronic  phthisis. 
Pneumothorax.  Montreal  Gen.  Hosp.  Path.  Rep.  (1876-77), 
1878,  i,  78-79. 

Small  cavity  and  caseous  masses  in  lung.  General  tuberculosis. 
Meninges  of  brain  unaffected;  central  softening.  Spinal  men- 
inges extensively  involved.     Montreal  Gen.  Hosp.  Path.  Rep. 

(1876-77),  1878,  i,  79-81. 

Meningeal  affection  slight.  Ventricles  distended,  walls  soft.  Very 
few  miliary  tubercles  in  the  organs.  Montreal  Gen.  Hosp. 
Path.  Rep.  (1876-77),  1878,  i,  81-82. 

Meningeal  affection  very  extensive  on  the  cortex,  slight  at  the  base. 
Ventricles  large,  walls  not  soft.  Large  caseous  mass  in  left 
lung.  Miliary  tubercles  in  lungs  and  on  peritoneum.  Mon- 
treal Gen.  Hosp.  Path.  Rep.  (1876-77),  1878,  i,  82-83. 

Slight  meningeal  inflammation.  One  caseous  mass  and  a  few 
tubercles  in  lungs.  Old  morbus  coxae.  Montreal  Gen.  Hosp. 
Path.  Rep.  (1876-77),  1878,  i,  84. 


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Profound  anaemia  without  discoverable  lesion.  Fatty  degeneration 
of  organs.  Hyperplasia  of  bone-marrow.  Montreal  Gen.  Hosp. 
Path.  Rep.  (1876-77),  1878,  i,  84-97. 

Ueber  die  Entwickelung  von  Blutkorperchen  im  Knochenmark  bei 
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Osier,  W.,  and  Ross,  G.:     Aneurism  of  hepatic  artery;    multiple 
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vi,  1-12. 
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1879 

Case  of  obliteration  of  vena  cava  inferior,  with  great  stenosis  of 
orifices  of  hepatic  veins.    J.  Anat.  &  Physiol.,  Lond.,  1878-79, 
xiii,  291-304. 
In  his:  Collect,  repr.,  1872-82,  i,  no.  24. 

Two  cases  of  rare  kidney  tumors.  Canada  M.  Rec,  Montreal,  1879, 
vii,  164. 

Miner's  phthisis  (Rep.  by  R.  Dawson).     Canada  M.  &  S.  J.,  Mon- 
treal, 1878-79,  vii,  452-454. 
Also:  Montreal  Gen.  Hosp.  Rep.,  1880,  1,  297-299. 

Acute  Bright's  disease  in  a  child;  remarkable  persistence  of  blood- 
corpuscles  and  casts  in  the  urine  after  disappearance  of 
albumin.  (Rep.  by  A.  Henderson.)  Canada  M.  &  S.  J.,  Mon- 
treal, 1878-79,  vii,  455. 

Aphasia,  with  right-sided  hemiplegia,  coming  on  fifteen  days  after 
delivery.  [Rep.  by  D.  Mignault.]  Canada  M.  &  S.  J.,  Montreal, 
1878-79,  vii,  492-493. 

Acute  rheumatism  treated  with  salicylate  of  soda.  Delirium  ap- 
parently caused  by  the  remedy.  [Rep.  by  B.  E.  Mackenzie.] 
Canada  M.  &  S.  J.,  Montreal,  1878-79,  vii,  493-494. 

Cohnheim's  theory  of  tumors.  Transl.  and  condensed  from  vol.  I 
of  his  Vorlesungen  iiber  allgemeine  Pathologie  (Lectures  upon 
general  pathology).  By  Dr.  Osier.  Canada  M.  &  S.  J.,  Mon- 
treal, 1878-79,  vii,  337-347;  398-408. 

1880 

Concussion  of  brain;  temporary  hemiplegia;  general  convulsions; 
rapid  recovery.    [Rep.  by  Imrie.]    Canada  M.  &  S.  J.,  Montreal. 

1879-80,  viii,  8. 

Aggravated  stuttering,  following  fall  on  the  head.  Canada  M.  & 
S.  J.,  Montreal,  1879-80,  viii,  9. 

Extreme  irregularity  of  the  heart.  [Rep.  by  E.  J.  Rogers.]  Canada 
M.  &  S.  J.,  Montreal,  1879-80,  viii,  9. 

Chronic  pleurisy;  flattening  of  sides  of  chest.    Canada  M.  &  S.  J., 
Montreal,  1879-80,  viii,  109-111. 
9 


128  Sir  William  Osler,  Baet. 

Croup  or  diphtheria;  which?    Canada  M.  &  S.  J.,  Montreal,  1879-80, 
viii,  207-211. 
In  his:  Collect,  repr.,  1872-82,  i,  no.  23. 

Three  cases  of  brain  disease.  Canada  M.  &  S.  J.,  Montreal,  1879-80, 
viii,  295;  346. 

Anomalous  case  of  pyaemia;  suppuration  about  tissues  in  left 
inferior  carotid  triangle;  pysemic  abscess  beneath  tensor 
vaginse  femoris;  pyaemic  infarcts  in  the  lungs;  septic  pleurisy. 
Canada  M.  &  S.  J.,  Montreal,  1879-80,  viii,  544-548. 

Catalogue  of  a  series  of  specimens  illustrative  of  the  morbid 
anatomy  of  the  brain  and  spinal  cord.  Exhibited  at  Ottawa 
Meeting  of  Canada  Medical  Association,  Sept.  1  and  2,  1880. 

Case  of  congenital  and  progressive  hypertrophy  of  the  right  upper 
extremity.    J.  Anat.  &  Physiol.,  Lond.,  1879-80,  xiv,  10-12. 
In  Ms:   Collect,  repr.,  1872-82,  i,  no.  25. 

Two  cases  of  striated  myo-sarcoma  of  the  kidney.     J.  Anat.  & 
Physiol.,  Lond.,  1879-80,  xiv,  229-233. 
In  his:  Collect,  repr.,  1872-82,  i,  no.  26. 

Cases  of  cardiac  abnormalities.    Montreal  Gqn.  Hosp.  Rep.,  1880,  i, 
177-192. 
In  his:  Collect,  repr.,  1872-82,  i,  no.  27. 

On  the  condition  of  fusion  of  two  segments  of  the  semilunar  valves. 
Montreal  Gen.  Hosp.  Rep.,  1880,  i,  233-242. 
In  his:  Collect,  repr.,  1872-82,  i,  no.  28. 

Wound  of  the  central  part  of  the  1st  and  2d  frontal  convolutions 
on  left  side.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  257-258. 

Bullet  wound  of  right  frontal  lobe;  entire  absence  of  cerebral 
symptoms.     Montreal  Gen.  Hosp.  Rep.,  1880,  i,  258-260. 

Cases  of  aneurism  of  the  aorta.  Montreal  Gen.  Hosp.  Rep.,  1880,  i, 
260-265. 

Aneurism  of  innominate-rupture  of  saccular  dilatation  of  aorta 
into  pericardium.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  265-266. 

Aneurism  of  splenic  artery;  perforation  into  transverse  colon. 
Montreal  Gen.  Hosp.  Rep.,  1880,  i,  266-268. 

Small  aneurism  of  renal  artery.  Montreal  Gen.  Hosp.  Rep.,  1880,  i, 
268. 

Four  cases  of  intracranial  aneurism.    Montreal  Gen.  Hosp.  Rep., 

1880,  i,  268-275. 

Aneurisms  of  branches  of  pulmonary  artery  on  wall  of  cavities; 
haemoptysis  in  chronic  phthisis.  Montreal  Gen.  Hosp.  Rep., 
1880,  i,  275-276. 

Two  cases  of  hypertrophy  of  the  heart.  Montreal  Gen.  Hosp.  Rep., 
1880,  i,  276-282. 

Perforation  of  pulmonary  artery  by  ulcer  of  left  bronchus;  sudden 
death  from  haemoptysis;  chronic  bronchitis,  emphysema, 
phthisis.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  282-283. 

Instance  of  four  pulmonary  valves.  Montreal  Gen.  Hosp.  Rep., 
1880,  i,  284. 


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Bayonet  wound  of  left  subclavian  artery  at  its  origin.  Montreal 
Gen.  Hosp.  Rep.,  1880,  i,  284. 

Patty  degeneration  of  heart  in  diphtheria;  sudden  death  on  the 
thirteenth  day.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  285. 

Two  cases  of  thrombosis  of  pulmonary  artery.  Montreal  Gen. 
Hosp.  Rep.,  1880,  i,  285-287. 

Thrombosis  of  branches  of  right  pulmonary  artery.  Montreal  Gen. 
Hosp.  Rep.,  1880,  i,  287-290. 

CEdema  of  right  lung;  hydrothorax  of  left  pleura;  contracted 
kidneys.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  290-291. 

CEdema  of  left  lung;  morphia  poisoning.  Montreal  Gen.  Hosp. 
Rep.,  1880,  i,  291-292. 

Pneumonia;  ulcerative  endocarditis;  meningitis.  Montreal  Gen. 
Hosp.  Rep.,  1880,  i,  292-295. 

Pneumonic  phthisis.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  295-297. 

Note  on  the  occurrence  of  membrane  in  the  trachea  and  bronchi  in 
diphtheria.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  299-300. 

Foreign  body  in  oesophagus ;  ulceration;  perforation;  retro-pharyn- 
geal  and  oesophageal  abscess.  Montreal  Gen.  Hosp.  Rep.,  1880, 
i,  300-301. 

Three  cases  of  cancer  of  the  stomach.  Montreal  Gen.  Hosp.  Rep., 
1880,  i,  301-302. 

Three  cases  of  ulcer  of  the  stomach.  Montreal  Gen.  Hosp.  Rep., 
1880,  i,  304-306. 

Three  cases  of  simple  ulcer  of  duodenum.  Montreal  Gen.  Hosp. 
Rep.,  1880,  i,  306-311. 

Typhoid  fever;  rapidly  fatal,  with  nervous  symptoms.  Montreal 
Gen.  Hosp.  Rep.,  1880,  i,  311-312. 

Perforation  of  appendix  vermiformis;  circumscribed  abscess;  per- 
foration of  ileum;  haemorrhage  from  bowels.  Montreal  Gen. 
Hosp.  Rep.,  1880,  i,  313-314. 

Liver;  hydatid  cyst.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  314-316. 

Primary  cancer  of  liver.  Montreal  Gen.  Hosp.  Rep.,  1880,  i,  316-317. 

Cirrhosis  of  liver;  collateral  circulation  by  means  of  an  enlarged 
umbilical  vein;  death  from  pneumonia.  Montreal  Gen.  Hosp. 
Rep.,  1880,  i,  317-318. 

Pylephlebitis.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  318-321. 

Extensive  scald  of  thorax;  pneumonia;  numerous  spots  of  fatty 
degeneration  in  kidneys.  Montreal  Gen.  Hosp.  Rep.,  1880,  i, 
321-322. 

Small  contracted  kidneys;  left  organ  affected  to  an  unusual 
degree;  right  only  involved  in  the  lower  part;  hypertrophy  of 
heart.     Montreal  Gen.  Hosp.  Rep.,  1880,  i,  322-324. 

Large  cirrhotic  kidneys  (congested);  hypertrophy  of  heart; 
apoplexy.     Montreal  Gen.  Hosp.  Rep.,  1880,  i,  324-325. 

Sarcoma  of  left  kidney.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  325-328. 


130  SiK  William  Oslek,  Bakt. 

Dermoid  of  ovary;  ulcerative  colitis.  Montreal  Gen.  Hosp.  Rep., 
1880,  i,  328-329. 

Cancer  of  neck  of  uterus;  constriction  of  right  ureter;  pyoneph- 
rosis.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  329-331. 

Ruptured  follicle  in  right  ovary;  peritonitis.  Montreal  Gen.  Hosp. 
Rep.,  1880,  i,  331-333. 

Extra-uterine  (abdominal)  pregnancy.  Montreal  Gen.  Hosp.  Rep., 
1880,  i,  333-335. 

Cryptorchidismus.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  335-336. 

Medullary  sarcoma  of  axillary  glands;  secondary  masses  in  heart, 
lungs,  stomach,  intestines,  liver,  spleen,  kidneys,  suprarenal 
capsules,  and  pancreas.  Montreal  Gen.  Hosp.  Rep.,  1880,  i, 
336-339. 

Sarcoma  of  retro-peritoneal  glands;  Lobstein  cancer.  Montreal 
Gen.  Hosp.  Rep.,  1880,  i,  339-340. 

Lympho-sarcoma  of  deep  cervical  glands,  involving  the  thyroid  and 
simulating  goitre.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  340-342. 

On  Giacomini's  method  of  preserving  the  brain.  Med.  Rec,  N.  Y., 
1880,  xvii,  315-316. 

On  the  systolic  brain  murmur  of  children.    Boston  M.  &  S.  J.,  1880, 
ciii,  29-30. 
In  his:  Collect,  repr.,  1872-82,  i,  no.  30. 

On  heredity  in  progressive  muscular  atrophy  as  illustrated  in  the 
Parr  family  of  Vermont.    Arch.  Med.,  N.  Y.,  1880,  iv,  316-320. 
In  Ms:  Collect,  repr.,  1872-82,  i,  no.  33. 

On  a  remarkable  heart-murmur,  heard  at  a  distance  from  chest- 
wall.    Med.  Times  &  Gaz.,  Lond.,  1880,  ii,  432. 
In  Ms:   Collect,  repr.,  1872-82,  i,  no.  34. 

Lympho-sarcoma  of  deep  cervical  glands,  involving  the  thyroid  and 
simulating  goitre.    Montreal  Gen.  Hosp.  Rep.,  1880,  i,  340-342. 

Montreal  General  Hospital.    Pathological  reports.    1.  (1876-77) ;  2. 
(1877-79),   Montreal,   1878-80.      (2.   report  repr.  from:    Mon- 
treal Gen.  Hosp.  Rep.,  Clin.  &  Path.,  1880,  i.) 
1  and  2  also  in  Ms:  Published  Mem.  &  Communicat,  Montreal, 

1882. 
[Collect,  repr.,  1872-82,  i,  nos.  22  &  29.] 

Catalogue  of  a  series  of  specimens  illustrative  of  the  morbid  anat- 
omy of  the  brain  and  spinal  cord.  Exhibited  at  Ottawa  meet- 
ing of  the  Canada  Medical  Association,  Sept.  1st  and  2d,  1880. 

Osier,  W.,  ed.  Montreal  General  Hospital.  Reports,  clinical  and 
pathological,  by  the  medical  staff,  v.  i,  Montreal,  1880,  Daw- 
son Brothers,  390  p.,  8°. 

1881 

On  some  points  in  the  etiology  and  pathology  of  ulcerative  endo- 
carditis.    Lond.,  1881,  J.  W.  Kolckmann,  8  p.,  8°. 
Tr.  Internat.  M.  Cong.,  7.  sess.,  Lond.,  1881,  i,  341-346. 
In  Ms:   Collect,  repr.,  1882-92,  ii,  no.  44. 


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Canada  Lancet,  Toronto,  1880,  xiii,  353-359. 

In  his:   Collect,  repr.,  1872-82,  i,  no.  42. 

On  some  of  the  effects  of  the  chronic  impaction  of  gallstones  in  the 
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1882 

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Clinical  remarks  on  cases  of  inherited  syphilis.    Canada  M.  &  S.  J., 
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On  the  brains  of  criminals.  With  a  description  of  the  brains  of  two 
murderers.    Canada  M.  &  S.  J.,  Montreal,  1881-82,  x,  385-398. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  45. 

Case  of  obliteration  of  the  portal  vein   (pylephlebitis  adhesiva). 
J.  Anat.  &  Physiol.,  Lond.,  1881-82,  xvi,  208-216. 
In  Ms:  Collect,  repr.,  1882-92,  ii,  no,  46. 

Ueber  den  dritten  Formbestandteil  des  Blute^.     Centralbl.  f.  d. 
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Summer  session  clinics.    No.  1.    Cases  of  inherited  syphilis.    No.  2. 
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A  clinical  lecture  on  empyema  and  its  antiseptic  treatment.    Med. 
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Uraemic  delirium  and  coma  at  a  very  early  stage  of  interstitial 
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Atheromatous  plate  and  ulcers  on  arch  of  aorta.     Med.  News, 
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Atheromatous  abscess  and  aneurism  of  the  right  iliac  artery;  gen- 
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An  address  on  the  haematozoa  of  malaria.    Brit.  M.  J.,  Lond.,  1887, 
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Antifebrin.    Therap.  Gaz.,  Detroit,  1887,  3.  s.,  iii,  163-167. 
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The  cardiac  relations  of  chorea.    Am.  J.  M.  Sc,  Phila.,  1887,  n.  s., 
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On  the  general  etiology  and  symptoms  of  chorea,  based  on  the 
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Case  of  cholesteatoma  of  floor  of  third  ventricle  and  of  the  in- 
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1888 

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The  diagnosis  of  small-pox.    Med.  Standard,  Chicago,  1888,  iii,  97. 
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Note  on  intrathoracic  growths  developing  from  the  thyroid  gland. 
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On  a  case  of  simple  idiopathic  muscular  atrophy,  involving  the 
face  and  the  scapulo-humeral  muscles.    Am.  J.  M.  Sc,  Phila., 
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Case  of  syphiloma  of  the  cord  of  the  cauda  equina;   death  from 
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In  his:   Collect,  repr.,  1882-92,  ii,  no.  100. 

Idiocy  and  feeble-mindedness  in  relation  to  infantile  hemiplegia; 
a  report  of  twenty-two  cases  at  the  Pennsylvania  Institution 
for  Feeble-Minded  Children.  Alienist  &  Neurol.,  St.  Louis, 
1889,  X,  16-23. 

1890 

On  the  value  of  Laveran's  organisms  in  the  diagnosis  of  malaria. 
The  Johns  Hopkins  Hosp.  Bull.,  Bait,  1889-90,  i,  II. 
In  Ms:  Collect  repr.,  1882-92,  ii,  no.  101. 


Bibliography  139 


On  fever  of  hepatic  origin,  particularly  the  intermittent  pyrexia 
associated  with  gallstones.    Johns  Hopkins  Hosp.  Rep.,  Bait., 
1890,  ii,  3-31. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  102. 

Cases  of  post-febrile  insanity.    Johns  Hopkins  Hosp.  Rep.,  Bait., 
1890,  ii,  46-50. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  103. 

Rare  forms  of  cardiac  thrombi.    Johns  Hopkins  Hosp.  Rep.,  Bait., 
1890,  ii,  56-61. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  104. 

Note  on  endocarditis  in  phthisis.     Johns  Hopkins  Hosp.   Rep., 
Bait.,  1890,  ii,  62-64. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  105. 

Tubercular   peritonitis;    general    considerations;    tubercular   ab- 
dominal tumors;  curability.    Johns  Hopkins  Hosp.  Rep.,  Bait., 
1890,  ii,  67-113. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  106. 

Acute  nephritis  in  typhoid  fever.     Johns  Hopkins  Hosp.  Rep., 
Bait,  1890,  ii,  119-128. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  107. 

On  the  amoeba  coli  in  dysentery  and  in  dysenteric  liver  abscess. 
Johns  Hopkins  Hosp.  Bull.,  Bait.,  1889-90,  i,  53-54. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  108. 

On  the  form  of  convulsive  tic,  associated  with  coprolalia,  etc. 
Med.  News,  Phila.,  1890,  Ivii,  645-647. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  109. 

On  the  symptoms  of  chronic  obstruction  of  the  common  bile-duct 
by  gallstones.    Ann.  Surg.,  St.  Louis,  1890,  xi,  161-185. 

Ueber  die  in  Dysenteric  und  dysenterischen  Leberabscess  vor- 
handene  Amoeba,  Centralbl.  f.  Bacteriol.  u.  Parasitenkr., 
Jena.,  1890,  vii,  736-737. 

Multiple  thrombi-multiple  gangrene.  (Proc.  Johns  Hopkins  Hosp. 
Med.  Soc,  Oct.  22,  1889.)  Johns  Hopkins  Hosp.  Bull.,  Bait., 
1889-90,  i,  12. 

Fatal  hemorrhage  into  a  large  bronchocele.  (Proc.  Johns  Hop- 
kins Hosp.  Med.  Soc,  Nov.  18,  1889.)  Johns  Hopkins  Hosp. 
Bull.,  Bait.,  1889-90,  i,  23. 

Congenital  heart  disease.  (Proc.  Johns  Hopkins  Hosp.  Med.  Soc, 
Dec  2,  1889.)     Johns  Hopkins  Hosp.  Bull.,  Bait,  1889-90,  i,  34. 

Filaria  sanguinis  hominis.  (Proc.  Johns  Hopkins  Hosp.  Med. 
Soc,  Jan.  6,  1890.)  Johns  Hopkins  Hosp.  Bull.,  Bait,  1889-90. 
i,  48. 

Weir  Mitchell.  Remarks  on  the  occasion  of  the  presentation  to 
the  College  of  Physicians,  Phila.,  of  the  portrait  of  Dr.  S.  Weir 
Mitchell,  April  22,  1890.  Johns  Hopkins  Hosp.  Bull.,  Bait, 
1889-90,  i,  64. 

Aortic  insufficiency.  (Proc.  Johns  Hopkins  Hosp.  Med.  Soc,  Oct. 
20,  1890.)     Johns  Hopkins  Hosp.  Bull.,  Bait.,  1889-90,  i,  109. 


140  Sir  William  Oslee,  Bart. 

Hereditary  chorea.     (Proc.  Johns  Hopkins  Hosp.  Med.  Soc,  Oct. 
20,  1890.)     Johns  Hopkins  Hosp.  Bull.,  Bait,  1889-90,  i,  110. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  114. 

General   bronchiectasis   of  left  lung,   foetid   bronchitis;    incision 
of  cavity;    death.      (Proc.  Johns  Hopkins  Hosp.  Med.   Soc, 
Oct.  20,  1890.)     Johns  Hopkins  Hosp.  Bull.,  Bait,  1889-90,  i, 
109. 
In  his:  Collect  repr.,  1882-92,  ii,  no.  115. 

1891 

A  case  of  sensory  aphasia;  word-blindness  with  hemianopsia.    Am. 
J.  M.  Sc,  Phila.,  1891,  n.  s.,  ci,  219-224. 
In  his:  Collect  repr.,  1882-92,  ii,  no.  110. 

Rudolf  Virchow;   the  man  and  the  student.     Boston  M.  &  S.  J., 
1891,  cxxv,  425-427. 
Also:  Johns  Hopkins  Univ.  Circ,  Bait,  1891,  xi,  17-19. 
In  his:  Collect  repr.,  1882-92,  ii,  no.  111. 

Diagnosis  of  tuberculous  broncho-pneumonia  in  children.     Arch. 
Pediat.,  Phila.,  1891,  viii,  825-829. 
Also:  Tr.  Am.  Pediat  Soc.  (N.  Y.),  1892,  iii,  25-29. 
In  his:  Collect  repr.,  1882-92,  no.  112. 

Doctor  and  nurse;  remarks  to  the  first  class  of  graduates  from 
the  Training  School  for  Nurses  at  The  Johns  Hopkins  Hos- 
pital.   Bait.,  1891,  J.  Murphy  &  Co.,  11  p.    4". 
In  his:   Collect  repr.,  1882-92,  ii,  no.  113. 

Obstruction  of  the  superior  vena  cava.      (Proc.  Johns  Hopkins 
Hosp.  Med.  Soc,  Jan.  5,  1891.)     Johns  Hopkins  Hosp.  Bull., 
Bait.,  1891,  ii,  40. 
In  his:  Collect  repr.,  1882-92,  ii,  no.  116. 

Case  of  multiple  cysticerci.     (Proc.  Johns  Hopkins  Hosp.  Med. 
Soc,  Feb.  2,  1891.)     Johns  Hopkins  Hosp.  Bull.,  Bait.,  1891, 
ii,  61. 
In  his:  Collect  repr.,  1882-92,  ii,  no.  117. 

Disease  of  the  coronary  arteries;  fibroid  heart  Tr.  Path.  Soc 
Phila.  (1887-9),  1891,  xiv,  106-108. 

Acute  phthisis;  erosion  of  a  large  branch  of  the  pulmonary 
artery;  sudden  fatal  haemoptysis.  Tr.  Path.  Soc  Phila. 
(1887-9),  1891,  xiv,  169. 

The  diagnosis  of  broncho-pneumonia  (acute  and  chronic)  from 
tuberculosis.    N.  York  M.  J.,  1891,  liv,  666. 

Report  on  the  Koch  treatment  in  tuberculosis.  Johns  Hopkins 
Hosp.  Bull.,  Bait.,  1891,  ii,  7-14. 

Remarks  on  hysteria  with  paroxysmal  inspiratory  spasm.  (Proc. 
Johns  Hopkins  Hosp.  Med.  Soc,  Nov.  17,  1890.)  Johns  Hop- 
kins Hosp.  Bull.,  Bait,  1891,  ii,  18. 

Two  cases  of  pernicious  malaria.  (Proc.  Johns  Hopkins  Hosp. 
Med.  Soc,  Oct  5,  1891.)  Johns  Hopkins  Hosp.  Bull.,  Bait., 
1891,  ii,  161-162. 

Richard  Lea  MacDonnell  (Obituary).    N.  York  M.  J.,  1891,  liv,  162. 


BiBLIOGKAPHY  141 


1892 

The  principles  and  practice  of  medicine.  Designed  for  the  use 
of  practitioners  and  students  of  medicine.  New  York,  1892, 
D.  Appleton  &  Co.,  1079  p.  8°. 

Teacher  and  student.     An  address  delivered  on  the  occasion  of 
the  opening  of  the  new  building  of  the  College  of  Medicine 
and   Surgery  of  the  University  of  Minnesota.     Minneapolis, 
Oct.  4,  1892,  Bait,  1892,  J.  Murphy  &  Co.,  22  p.  8°. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  123. 

Collected  reprints.  Second  series.  (January  1,  1882-January  1, 
1892.)     [Bait.,  1892.]     8°. 

Remarks  on  specialism.     Boston  M.  &  S.  J.,  1892,  cxxvi,  457-459. 
Also:  Med.  News,  Phila.,  1892,  Ix,  542-544. 
Also:   Arch.  Pediat.,  Phila.,  1892,  ix,  481-488. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  118. 

The  healing  of  tuberculosis.     Climatologist,  Phila.,  1892,  ii,  149- 
153. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  119. 

On  the  association  of  congenital  wry-neck,   with  marked   facial 
asymmetry.    Arch.  Pediat.,  N.  Y.,  1892,  ix,  81-85. 
In  his:  Collect,  repr.,  1882-92,  ii,  no.  120. 

Interstitial  processes  in  the  central  nervous  system.     Tr.  Cong. 
Am.  Phys.  &  Surg.,  1891,  N.  Haven,  1892,  ii,  144-146. 
In  his:   Collect,  repr.,  1892-7,  iii,  no.  121. 

The  cold-bath  treatment  of  typhoid   fever.     Med.   News,   Phila., 
1892,  Ixi,  628-631. 
In  his:  Collect,  repr.,  1892-7^  iii,  no.  122. 

Notes  on  the  diagnosis  and  treatment  of  cholera.  Med.  News, 
Phila.,  1892,  Ixi,  290. 

License  to  practice.    Northwest-Lancet,  St.  Paul,  1892,  xii,  383. 

An  acute  myxoedematous  condition  occurring  in  goitre.  (Proc. 
Johns  Hopkins  Hosp.  Med.  Soc,  Dec.  7,  1891.)  Johns  Hop- 
kins Hosp.  Bull.,  Bait.,  1892,  iii,  42. 

Chronic  cerebro-spinal  meningitis.  (Proc.  Johns  Hopkins  Hosp. 
Med.  Soc,  Oct.  17,  1892.)  Johns  Hopkins  Hosp.  Bull.,  Bait., 
1892,  iii,  119. 

Localized  pyo-pneumothorax.  (Proc.  Johns  Hopkins  Hosp.  Med. 
Soc,  Oct.  17,  1892.)  Johns  Hopkins  Hosp.  Bull.,  Bait,  1892, 
iii,  19. 

1893 

Note  on  arsenical  neuritis  following  the  use  of  Fowler's  solution. 
(,^4  31  mis.)     Montreal  M.  J.,  1892-3,  xxi,  721-724. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  130. 

Note  on  a  remarkable  house  epidemic  of  typhoid  fever.     Univ. 
M.  Mag.,  Phila.,  1892-3,  v,  522-524. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  131. 

Tuberculous  pericarditis.     Am.  J.  M.  Sc,  Phila.,  1893,  n.  s.,  cv, 
20-27. 
In  his:  Collect  repr.,  1892-7,  iii,  no.  124. 


142  Sir  William  Osler,  Bart. 

On  dilatation  of  the  colon  in  young  children.    Arch.  Pediat,  N.  Y., 

1893,  X,  111-119. 
Also:    (Proc.  Johns  Hopkins  Hosp.  Med.  Soc,  Jan.  16,  1893.) 

Johns  Hopkins  Hosp.  Bull.,  Bait,  1893,  iv,  41-43. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  125. 

Physic  and  physicians  as  depicted  in  Plato.     Boston  M.  &  S.  J., 
1893,  cxxviii,  129;  153. 
In  Ms:  Collect,  repr.,  1892-7,  iii,  no.  126. 

Case  of  arterio-venous  aneurism  of  the  axillary  artery  and  vein 
of  fourteen  years'  duration.     Ann.  Surg.,  Phila.,  1893,  xvii, 
37-40. 
In  his:   Collect,  repr.,  1892-7,  iii,  no.  127. 

The   chronic   intermittent   fever   of   endocarditis.     Practitioner, 
Lond.,  1893,  1,  181-190. 
In  his:   Collect,  repr.,  1892-7,  iii,  no.  128. 

Remarks  on  the  varieties  of  chronic  chorea,  and  a  report  upon 
two    families    of   the    hereditary    form,    with    one   autopsy. 
J.  Nerv.  &  Ment.  Dis.,  N.  Y.,  1893,  xx,  97-111. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  129. 

Cases  of  sub-phrenic  abscess.     Tr.  Ass.  Am.  Physicians,  Phila., 
1893,  viii,  257-267. 
Also:   Canad.  Pract,  Toronto,  1893,  xviii,  565-574. 
In  his:   Collect,  repr.,  1892-7,  iii,  no.  132. 

Shattuck  lecture.     Mass.  Med.  Soc,  1893.     Tuberculous  pleurisy. 
Boston  M.  &  S.  J.,  1893,  cxxix,  53;  81;  109;   134. 
Also:  Med.  Communicat.  Mass.  M.  Soc,  Boston,  1893,  xvi,  49-112. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  133. 

Profound  toxemia  with  slight  tuberculous  lesions.  Med.  News, 
Phila.,  1893,  Ixiii,  632. 

Jean  Martin  Charcot,  memorial  notice.  Johns  Hopkins  Hosp. 
Bull.,  Bait.,  1893,  iv,  87-88. 

On  sporadic  cretinism  in  America.     Tr.  Am.  J.  Am.  Physicians, 
Phila.,  1893,  viii,  380-398. 
Also:  Am.  J.  M.  Sc,  Phila.,  1893,  n.  s.,  cvi,  503-518. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  136. 

Notes  on  tuberculosis  in  children.     Arch.  Pediat,  N.  Y.,  1893, 
X,  979-986. 
In  his:  Collect  repr.,  1892-7,  iii,  no.  137. 

Hirt,  Ludwig.  The  diseases  of  the  nervous  system.  A  text-book 
for  physicians  and  students.  Transl.  with  permission  of  the 
author  by  August  Hoch,  assisted  by  Frank  R.  Smith,  with 
an  introduction  by  William  Osier,  N.  Y.,  1893.  D.  Appleton 
&  Co.,  698  p.  8°. 

1894 

Lectures  on  the  diagnosis  of  abdominal  tumors,  delivered  to  the 
post-graduate   class,   Johns  Hopkins  University,   1893.     New 
York,  1894,  D.  Appleton  &  Co.,  192  p,  8°. 
Also:    N.  York  M.  J.,  1894,  lix,  129;   161;   193;   260;   385;   417; 

481;  545;  577:    Ix,  65;  97. 
In  his:  Collect  repr.,  1892-7,  iii,  no.  146. 


Bibliography  143 

On  chorea  and  choreiform  affections.     Phila.,  P.  Blakiston,  Son 
&  Co.,  1894,  125  p.     8°. 
In  his:   Collect,  repr.,  1892-7,  iii,  no.  149. 

Tuberculosis. 

In:   Am.  Text-Bk.  Dis.  Child.     (Starr),  Phila.,  1894,  94-126. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  134. 

Diseases  of  the  blood. 
In:   Text-book  Theory  &  Pract.  Med.  (Pepper),  Phila.,  1894,  ii, 

182-233. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  135. 

Diseases  of  the  suprarenal  capsules  and  ductless  glands. 

In:   Text-book  Theory  &  Pract.  Med.   (Pepper),  Phila.,  1894,  ii, 
234-246. 

Toxaemia  in  tuberculosis.    Practitioner,  Lond.,  1894,  Iii,  26-30. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  138. 

Parotitis  in  pneumonia.    Case  of  pericarditis  treated  by  incision 
and  drainage.     Univ.  M.  Mag.,  Phila.,  1893-4,  vi,  245-249. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  139. 

The  army  surgeon.     An  address  delivered  at  the  closing  exer- 
cises of  the  Army  Medical  School,  Washington,  D.  C,  Feb.  28, 
1894.    Med.  News,  Phila.,  1894,  Ixiv,  318-322. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  147. 

The  leaven  of  science.     An  address  delivered  at  the  opening  of 
the  Wistar  Institute  of  Anatomy  and  Biology  of  the  Univer- 
sity of  Pennsylvania,  May  21,  1894.     Univ.  M.  Mag.,  Phila., 
1893-4,  vi,  573-586. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  148. 

Oliver  Wendell  Holmes.     Johns  Hopkins  Hosp.  Bull.,  Bait.,  1894, 
V,  85-88. 
In  his:   Collect,  repr.,  1892-7,  iii,  no.  150. 

The  heart  in  chorea  minor.  Med.  Chron.,  Manchester,  1894,  n.  s., 
1,  321-332. 

Clinical  remarks  on  a  case  of  typhoid  fever,  complicated  with 
bronchitis  and  laryngitis.  Maryland  M.  J.,  Bait.,  1894,  xxxi, 
1-3. 

The    registration    of    pulmonary    tuberculosis.      Phila.    Polyclin., 

1894,  iii,  65. 

Case  of  hereditary  chorea.  (Proc.  Johns  Hopkins  Hosp.  Med. 
Soc,  Oct.  1,  1894.)  Johns  Hopkins  Hosp.  Bull.,  Bait.,  1894, 
V,  119-120. 

1895 

The  principles  and  practice  of  medicine.  Designed  for  the  use 
of  practitioners  and  students  of  medicine.     2.  ed.  New  York, 

1895,  D.  Appleton  &  Co.,  1143  p.    8°. 

Report  on  typhoid  fever.  I.  General  analysis  and  summary  of 
the  cases.  II.  Treatment  of  typhoid  fever.  III.  A  study  of 
the  fatal  cases.  IV.  Notes  on  special  features,  symptoms 
and  complications.  Johns  Hopkins  Hosp.  Rep.,  Bait.,  1894-5, 
iv,  1-72. 
In  his:  Collect,  repr.,  1892-7,  iii,  nos.  140-143. 

10 


144  Sir  William  Osler,  Bart. 

On  the  neurosis  following  enteric  fever,  known  as  "  the  typhoid 
spine."    Johns  Hopkins  Hosp.  Rep.,  1894-5,  iv,  73-82. 
Also:  Am.  J.  M.  Sc,  Phila.,  1894,  n.  s.,  cvii,  23-30. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  144. 

Typhoid  fever  in  Baltimore.     Johns  Hopkins  Hosp.  Rep.,  Bait., 
1894-5,  iv,  159-167. 
In  Ms:  Collect,  repr.,  1892-7,  iii,  no.  145. 

Introductory  remarks  to   course  of  clinical   demonstrations   on 
typhoid  fever.    Maryland  M.  J.,  Bait.,  1894-5,  xxxii,  79-82. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  151. 

Cancer  of  the  stomach  with  very  rapid  course.     Univ.  M.  Mag., 
Phila.,  1894-5,  vii,  248-252. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  152. 

Teaching  and  thinking;   the  two  functions  of  a  medical  school. 
Montreal  M.  J.,  1894-5,  xxiii,  561-572. 
In  his:   Collect,  repr.,  1892-7,  iii,  no.  153. 

Case  of  sporadic  cretinism  (infantile  myxoedema)  treated  success- 
fully with  thyroid  extract.     Arch.  Pediat.,  N.  Y.,  1895,  xii, 
105-108. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  154. 

Diseases,  the  direct  or  indirect  result  of  infection.     Text-hook 
Nerv.  Dis.  Am.  Authors  (Dercum),  Phila.,  1895,  203-226. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  157. 

Studies  in  typhoid  fever:  Five  years'  experience  with  the  cold- 
bath  treatment.  Johns  Hopkins  Hosp.  Rep.,  Bait.,  1895,  v, 
321-326. 

Also:  Canada  M.  Rec,  Montreal,  1895-6,  xxiv,  56-60. 

Also:   Med.  News,  Phila.,  1895,  Ixvii,  393-395. 

Also:  Canada  Lancet,  Toronto,  1895-6,  xxviii,  261-263. 

In  his:  Collect,  repr.,  1892-7,  iii,  no.  158. 

Studies  in  typhoid  fever:    Analysis  and  summary  of  the  cases; 
special  features,  symptoms,  and  complications;   a  study  of 
the  fatal  cases.     Johns  Hopkins  Hosp.  Rep.,  Bait.,  1895,  v, 
281;  283;  459. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  159. 

Neuritis  during  and  after  typhoid  fever.     Johns  Hopkins  Hosp. 
Rep.,  Bait,  1895,  v,  397-416. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  160. 

Chills  in  typhoid  fever.     Johns  Hopkins  Hosp.  Rep.,  Bait.,  1895, 
V,  445-457. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  161. 

The  practical  value  of  Laveran's  discoveries.    Med.  News,  Phila., 
1895,  Ixvii,  561-564. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  162. 

On   the  visceral   complications   of  erythema   exudativum   multi- 
forme.   Am.  J.  M.  Sc,  Phila.,  1895,  n.  s.,  ex,  629-646. 
Also:   Select  essays  and  monog.,  Lond.,  1897,  321-347.     8°. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  163. 

Case  of  cerebral  haemorrhage  in  a  foetus.  Teratologia,  Lond.  & 
Edinb.,  1895,  ii,  13. 


BiBLIOGliAPHY  145 

Hyperpyrexia  in  typhoid  fever.  (Proc.  Johns  Hopkins  Hosp. 
Med.  Soc,  Oct.  7,  1895.)     Johns  Hopkins  Hosp.  Bull.,  Bait, 

1895,  vi,  143. 

Abscess  of  the  liver,  perforating  the  lung.  (Proc.  Johns  Hopkins 
Hosp.  Med.  Soc,  Oct.  7,  1895.)  Johns  Hopkins  Hosp.  Bull., 
Bait,  1895,  vi,  144. 

President's  address.    Tr.  Ass.  Am.  Physicians,  Phila.,  1895,  x,  xi-xv. 

1896 

An  Alabama  student.     Baltimore,  Friedenwald  Co.,  1896,   19  p. 
12°. 
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Typhoid  fever  in  country  districts.    Maryland  M.  J.,  Bait,  1895-6, 
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Visible  contractile  tumor  of  the  pylorus  following  ulcer  of  the 
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In  his:   Collect,  repr.,  1892-7,  iii,  no.  156. 

John  Keats,  the  apothecary  poet.     Baltimore,  Friedenwald  Co., 

1896.  18  p.     12°. 

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Thomas  Dover,  M.  D.    (of  Dover's  powder),   physician  and  buc- 
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Addison's  disease.    Med.  Bull.,  Phila.,  1896,  xviii,  81-84. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  168. 

On  the  association  of  enormous  heart  hypertrophy,  chronic  pro- 
liferative  peritonitis   and    recurring   ascites,   with   adherent 
pericardium.    Arch.  Pediat,  N.  Y.,  1896,  xiii,  1-10. 
In  his:  Collect,  repr.,  1892-7,  iii,  no.  169. 

Hemiplegia  in  typhoid  fever.     J.  Nerv.  &  Ment  Dis.,  N.  Y.,  1896, 
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Diseases  of  the  blood  and  the  ductless  glands. 

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The  cerebral  complications  of  Raynaud's  disease.    Am.  J.  M.  Sc, 
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Lectures  on  angina  pectoris  and  allied  states.     N.  York  M.  J., 
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146  Sir  William  Osler,  Bart. 

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Pleuro-peritoneal  tuberculosis.  (Proc.  Johns  Hopkins  Hosp.  Med. 
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Ephemerides,  1895: 
I.  Introduction. 
II.  Heberden's  nodes. 

III,  Geographical  tongue. 

IV.  Buccal  leucoplacia. 

V.  Acute  gout  in  the  United  States. 
VI.  Calcification  of  the  auricle. 
VII.  Arthritis  deformans  in  childhood. 
VIII.  Unusual  types  of  night-terrors;  day-terrors. 
IX.  Tobacco  angina. 
X.  Unusually  persistent  oxyuris. 
XI.  Is  the  coin  sound  distinctive  of  pneumothorax? 
XII.  Head-swaying  in  children. 

Montreal  M.  J.,  1895-6,  xxiv,  518;  631;  694;  777;  877;  969. 

1897 

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Collected  reprints.  Third  series.  (January  1,  1892- January  1, 
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On  six  cases  of  Addison's  disease,  with  the  report  of  a  case  greatly 
benefited  by  the  use  of  the  suprarenal  extract.     Internat.  M. 
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On   the   classification   of  the   tics   or  habit  movements.     Arch. 
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On  certain  features  in  the  prognosis  of  pneumonia.     Am.  J.  M. 
Sc,  Phila.,  1897,  n.  s.,  cxiii,  1-10. 
Also:  North  Car.  M.  J.,  Wilmington,  1897,  xxxix,  295-307. 
In  his:  Collect,  repr.,  1897-1902,  iv,  no.  175. 

Mitral  stenosis;  sudden  death;  ball  thrombus  in  the  left  auricle. 
Montreal  M.  J.,  1896-7,  xxv,  729-731. 
In  his:  Collect,  repr.,  1897-1902,  iv,  no.  176. 

The  diagnosis  of  malarial  fever.     Med.  News,  N.  Y.,  1897,  Ixx, 
289-292. 
In  his:  Collect,  repr.,  1897-1902,  iv,  no.  177. 

On  certain  unusual  forms  of  paraesthetic  meralgia.     J.  Nerv.  & 
Ment.  Dis.,  N.  Y.,  1897,  xxiv,  131-137. 
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Cerebro-soinal  fever. 
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Surgical  intervention  in  perforation  in  typhoid  fever.  Phila.  M.  J., 
1901,  vii,  138. 

On  perforation  and  perforative  peritonitis  in  typhoid  fever.    Phila. 
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Also:  St.  Louis  M.  &  S.  J.,  1901,  Ixxx,  254-264. 
In  his:  Collect,  repr.,  1897-1902,  iv,  no.  222. 

Books  and  men.    Remarks  made  at  the  opening  of  the  new  build- 
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The  past  century;  its  progress  in  great  subjects.    Medicine. 
In:  Sun,  N.  Y.,  1901,  Jan.  27. 
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The  progress  of  medicine  in  the  nineteenth  century.     [New  York, 
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In:  Progr.  Cent.    New  York  &  Lond.,  1901,  173-214,  8°. 

["  The  progress  of  medicine  "  the  same  as  "  The  past  century."] 

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152  Sir  William  Oslek,  Bart. 

The  medical  aspects  of  carcinoma  of  the  breast,  with  a  note  on  the 
spontaneous  disappearance  of  secondary  growths.    Am.  Med., 
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Hemorrhage  in  chronic  jaundice  (Correspondence).  Am.  Med., 
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On  the  advantages  of  a  trace  of  albumin  and  a  few  tube  casts  in 
the  urine  of  certain  men  above  fifty  years  of  age.  N.  York 
M.  J.,  1901,  Ixxiv,  949-950. 

Also:   Indian  M.  Rec,  Calcutta,  1902,  xxii,  92-93. 

In  his:  Collect,  repr.,  1897-1902,  iv,  no.  227. 

Congenital  absence  of  the  abdominal  muscles,  with  distended  and 
liypertrophied  urinary  bladder.     Johns  Hopkins  Hosp.  Bull., 
Bait,  1901,  xii,  331-333. 
In  his:  Collect,  repr.,  1897-1902,  iv,  no.  228. 

On  a  family  form  of  recurring  epistaxis,  assgciated  with  multiple 
telangiectases  of  the  skin  and  mucous  membranes.     Johns 
Hopkins  Hosp.  Bull.,  Bait,  1901,  xii,  333-337. 
In  his:  Collect,  repr.,  1897-1902,  iv,  no.  229. 

The  natural  method  of  teaching  the  subject  of  medicine.  J.  Am. 
M.  Ass.,  Chicago,  1901,  xxxvi,  1673-1679. 

The  study  of  internal  medicine.  Med.  News,  N.  Y.,  1901,  Ixxviii, 
645-647. 

The  spinal  form  of  arthritis  deformans.  Remarks  introductory  to 
a  discussion  on  the  subject    Tr.  Ass.  Am.  Physicians,  Phila., 

1901,  xvi,  687-689. 

1902 

The  principles  and  practice  of  medicine.  Designed  for  the  use 
of  practitioners  and  students  of  medicine.     5.  ed.  New  York, 

1902,  D.  Appleton  &  Co.,  1079  p.    8°. 

Collected  reprints.  Fourth  series.  (January  1,  1897-January  1, 
1902.)     [Bait,  1902.] 

On  the  diagnosis  of  bilateral  cystic  kidney.     Am.  Med.,  Phila., 
1902,  iii,  463-464. 
In  his:  Collect  repr.,  1902-1907,  v,  no.  230. 

On  amebic  abscess  of  the  liver.     Med.  News,  N.  Y.,  1902,  Ixxx, 
673-677. 
In  his:  Collect  repr.,  1902-1907,  v,  no.  231. 

Amebic  dysentery.    Therap.  Gaz.,  Detroit,  1902,  3.  s.,  xviii,  217-218. 
Also:  Proc.  Phila.  Co.  M.  Soc,  Phila.,  1902,  n.  s.,  iv,  44-46. 
In  his:  Collect,  repr.,  1902-1907,  v,  no.  232. 

Note  on  the  occurrence  of  ascites  in  solid  abdominal  tumors. 
Phila.  M.  J.,  1902,  ix,  928-929. 
In  his:  Collect,  repr.,  1902-1907,  v,  no.  233. 

Alfred  Stille.    Univ.  Penn.  Med.  Bull.,  Phila.,  1902,  xv,  126-132. 
In  his:  Collect,  repr.,  1902-1907,  v,  no.  234. 

Notes  on  aneurism.     J.  Am.  M.  Ass.,  Chicago,  1902,  xxxviii,  1483- 
1486. 
In  his:  Collect,  repr.,  1902-1907,  v,  no.  235. 


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Some  aspects  of  American  medical  bibliography.  Address  at  the 
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A  case  of  chronic  purpuric  erythema  (eight  years'  duration)  with 
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On  obliteration  of  the  superior  vena  cava.     Johns  Hopkins  Hosp. 
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154  Sir  William  Oslee,  Baet. 


On  the  so-called  Stokes-Adams  disease  (slow  pulse  with  syncopal 
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Chronic  cyanosis  with  polycythaemia  and  enlarged  spleen;  a  new 
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In  Ms:  Collect,  repr.,  1902-1907,  v,  no.  247. 

The  master-word  in  medicine.  An  address  to  medical  students 
on  the  occasion  of  the  opening  of  the  new  buildings  of  the 
Medical  Faculty  of  the  University  of  Toronto,  Oct.  1,  1903. 
Baltimore,  1903,  J.  Murphy  Co.,  33  p.    8°. 

Also:   Brit.  M.  J.,  Lond.,  1903,  ii,  1196-1200. 

Also:  Canad.  J.  M.  &  S.,  Toronto,  1903,  xiv,  333-347. 

Also:  Montreal  M.  J.,  1903,  xxxii,  771-785. 

Also:   Johns  Hopkins  Hosp.  Bull.,  Bait,  1904,  xv,  1-7. 

In  Ms:   Collect,  repr.,  1902-1907,  v,  no.  248. 

The  master-word  is  work,  1903 (?)  Date  of  publication  not  ascer- 
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Typhoid  fever  and  tuberculosis.    Am.  Med.,  Phila.,  1903,  vi,  1015- 
1016. 
In  Ms:  Collect,  repr.,  1902-1907,  v,  no.  249. 

The  home  in  its  relation  to  the  tuberculosis  problem.    Med.  News, 
N.  Y.,  1903,  Ixxxiii,  1105-1110. 
In  Ms:   Collect,  repr.,  1902-1907,  v,  no.  250. 

On  the  visceral  manifestations  of  the  erythema  group   of  skin 
diseases.    Tr.  Ass.  Am.  Physicians,  Phila.,  1903,  xviii,  599-624. 
Also:  Am.  J.  M.  Sc,  Phila.,  1904,  cxxvii,  1-23. 
In  Ms:  Collect,  repr.,  1902-1907,  v,  no.  251. 

Diabetes  in  infancy.    Phila.  M.  J.,  1903,  xi,  538. 

The  significance  of  cutaneous  angiomata.  Med.  News,  N.  Y.,  1903, 
Ixxxii,  91. 

The  varieties  of  linese  albicantes.  Med.  News,  N.  Y.,  1903,  Ixxxiii, 
904. 

Aneurism  of  upper  part  of  thoracic  aorta.  (Proc.  Johns  Hopkins 
Hosp.  Med.  Soc,  Oct.  20,  1902.)  Johns  Hopkins  Hosp.  Bull., 
Bait,  1903,  xiv,  85. 

Certain   forms   of   cyanosis    with   polycythaemia.      (Proc.    Johns 
Hopkins  Hosp.  Med.   Soc,  Nov.   17,  1902.)     Johns  Hopkins 
Hosp.  Bull.,  1903,  xiv,  91. 
Also:   Maryland  M.  J.,  Bait,  1903,  xlvi,  81-82. 

Two  cases  of  cirrhosis  of  the  liver  in  children.  (Proc.  Johns  Hop- 
kins Hosp.  Med.  Soc,  March  16,  1903.)  Johns  Hopkins  Hosp. 
Bull.,  Bait.,  1903,  xiv,  322. 

1904 

Aequanimitas,  with  other  addresses  to  medical  students,  nurses 
and  practitioners  of  medicine.  Phila.,  1904,  P.  Blakiston's  Son 
&  Co.     389  p.     12°. 


BiBLIOGRArHY  155 

The  same.    Lond.,  1904,  H.  K.  Lewis,  389  p.    12°. 

The  Ingersoll  lecture,  1904.  Science  and  immortality.  Boston, 
1904,  Houghton,  Mifflin  &  Co.     60  p.     12^ 

The  "  phthisiologia  "  of  Richard  Morton,  M.  D.    Med.  Libr.  &  Hist. 
J.,  Brooklyn,  1904,  ii,  1-7. 
In  his:   Collect,  repr.,  1902-1907,  v,  no.  252. 

Ochronosis:    the  pigmentation  of  cartilages,  sclerotics,  and  skin 
in  alkaptonuria.     Lancet,  Lond.,  1904,  i,  10-11. 
In  his:  Collect,  repr.,  1902-1907,  v,  no.  253. 

On  the  surgical  importance  of  the  visceral  crises  in  the  erythema 
group  of  skin  diseases.  Am.  J.  M.  Sc,  Phila.  &  N.  Y.,  1904, 
n.  s.,  cxxvii,  751-754. 

Also:  Johns  Hopkins  Hosp.  Bull.,  Bait,  1904,  xv,  259-261. 

In  his:  Collect,  repr.,  1902-1907,  v,  no.  254. 

Angina  pectoris  and  arterio-sclerosis.     J.  Am.  M.  Ass.,  Chicago, 

1904,  xliii,  775. 

Chronic  cyanotic  polycythaemia  with  enlarged  spleen.  Brit.  M.  J., 
Lond.,  1904,  i,  121. 

Korsakoff's  disease.    N.  York  M.  J.  [etc.],  1904,  Ixxix,  570. 

Vasomotor  mottling.  (Proc.  Johns  Hopkins  Hosp.  Med.  Soc, 
Nov.  16,  1903.)     Johns  Hopkins  Hosp.  Bull.,  Bait,  1904,  xv,  66. 

Aneurism  of  arch  of  aorta  and  innominate.  (Proc.  Johns  Hopkins 
Hosp.  Med.  Soc,  Nov.  16,  1903.)  Johns  Hopkins  Hosp.  Bull., 
Bait,  1904,  XV,  66. 

Remarks  at  the  unveiling  of  the  memorial  tablet  to  Dr.  Jesse  W. 
Lazear.     Johns  Hopkins  Hosp.  Bull.,  Bait,  1904,  xv,  387-388. 

The  home  in  its  relation  to  the  tuberculosis  problem.    Sanitarian, 
N.  Y.,  1904,  Hi,  322-336. 
Also:  Canada  Lancet,  Toronto,  1904-5,  xxxviii,  600-612. 

1905 

The  principles  and  practice  of  medicine,  designed  for  the  use  of 
practitioners  and  students  of  medicine.    6.  ed.  N.  Y.  &  Lond., 

1905,  D.  Appleton  &  Co.    1143  p.    8°. 

Counsels  and  ideals  from  the  writings  of  ...  .  [Selected  and 
edited  by  C.  N.  B.,  Camac]  Bost.  &  N.  Y.,  1905,  Houghton, 
Mifflin  &  Co.    277  p.    12°. 

Unity,  peace,  and  concord;  a  farewell  address  to  the  medical  pro- 
fession of  the  United  States.    Oxford,  1905,  H.  Hart  22  p.    8°. 
Also:   J.  Am.  M.  Ass.,  Chicago,  1905,  xlv,  365-369. 
Also:   St  Louis  M.  Rev.,  1905,  lii,  112-116. 
Also:  Maryland  M.  J.,  Bait,  1905,  xlviii,  412-422. 
In  his:  Collect  repr.,  1902-1907,  v,  no.  255. 

The  student  life.     A  farewell  address  to  Canadian  and  American 
medical  students.    Oxford  [19051.    H.  Hart     32  p.    8°. 
Also:   Canada  Lancet,  Toronto,  1905-6,  xxxix,  121-138. 
Also:  Med.  News,  N.  Y.,  1905,  Ixxxvii,  625-633. 
Also:   St  Louis  M.  Rev.,  1905,  lii,  273-283. 
In  his:  Collect  repr.,  1902-1907,  v,  no.  256. 


156  SiE  William  Osler,  Baet. 

Aneurism  of  the  abdominal  aorta.     Lancet,  Lend.,  1905,  ii,  1089- 
1096. 
In  his:  Collect,  repr.,  1902-1907,  v,  no.  257. 

Acute  tuberculous  pneumonia.    Brooklyn  ]\L  J.,  1905,  xix,  57-61. 

The  home  in  its  relation  to  the  tuberculosis  problem.    Rev.  inter- 
nat  de  la  tuberc.  Par.,  1905,  vii,  403-413. 
Also:  Rep.  Henry  Phipps  Inst,  study  ....  tuberculosis,  Phila., 

1905,  i,  141-154. 
Also:  Am.  J.  Tuberc,  Detroit,  1905,  i,  9-15. 

An  address  on  Sir  Thomas  Browne.  Brit.  M.  J.,  Lond.,  1905,  ii, 
993-998. 

The  Roval  Dental  Hospital  of  London:  address.  Lancet,  Lend., 
1905,  ii,  1210. 

Valedictory  address  at  Johns  Hopkins  University.  J.  Am.  M.  Ass., 
Chicago,  1905,  xliv,  705-710. 

Biliarj-  cirrhosis  of  family  type.  (Proc.  Johns  Hopkins  Hosp. 
Med.  Soc,  Nov.  7,  1904.)  Johns  Hopkins  Hosp.  Bull.,  Bait., 
1905,  xvi,  112-113. 

Report  of  a  case  of  ulcerative  endocarditis,  with  embolism  of  the 
aorta.  (Proc.  Johns  Hopkins  Hosp.  Med.  Soc,  Dec  19,  1904.) 
Johns  Hopkins  Hosp.  Bull.,  Bait.,  1905,  xvi,  118. 

Report  of  a  case  of  arterio-venous  aneurism  of  the  thigh.  (Proc. 
Johns  Hopkins  Hosp.  Med.  Soc,  Dec.  19,  1904.)  Johns  Hop- 
kins Hosp.  Bull.,  Bait,  1905,  xvi,  119. 

A  case  of  arterio-venous  aneurism.  (Proc.  Johns  Hopkins  Hosp. 
Med.  Soc,  Jan.  16,  1905.)  Johns  Hopkins  Hosp.  Bull.,  Bait, 
1905,  xvi,  146. 

Resume  of  history  of  blood  platelets.  (Proc.  Johns  Hopkins  Hosp. 
Med.  Soc,  March  6,  1905.)  Johns  Hopkins  Hosp.  Bull.,  Bait, 
1905,  xvi,  200. 

A  letter  to  graduate^  of  The  Johns  Hopkins  Medical  School.  Johns 
Hopkins  Hosp.  Bull.,  Bait,  1905,  xvi,  410. 

Stille,  A.  Table  of  comparison  between  typhus  and  typhoid  fevers. 
With  an  introductorv  note  bv  Professor  Osier.  Univ.  Penn.  M. 
BuU.,  Phila.,  1904-5,  xvii,  63-64. 

1906 

Aequanimitas.  with  other  addresses  to  medical  students,  nurses, 
and  practitioners  of  medicine,  2.  ed.  with  three  additional 
addresses.     Phila.,  1906,  P.  Blakiston's  Son  &  Co.,  475  p.     8°. 

The  same,  Lond.,  1906,  H.  K.  Lewis,  485  p.    8°. 

Convulsions  in  typhoid  fever.    Practitioner,  Lond.,  1906,  Ixxvi,  1-8. 
I7i  his:   Collect,  repr.,  1902-1907,  v,  no.  258. 

On  the  medical  aspects  of  carcinoma  of  the  breast.     Brit.  M.  J., 
Lond.,  1906,  i,  1-4. 
In  his:  Collect  repr.,  1902-1907,  v^  no.  259. 

Angina  pectoris  as  an  early  symptom  in  aneurism  of  the  aorta. 
Med.  Chron.,  Manchester,  1906,  xliv,  69-79. 
In  his:  Collect,  repr.,  1902-1907,  v,  no.  260. 


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1907 

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The  evolution  of  internal  medicine. 
In:  Mod.  Med.  (Osier),  Phila.  &  N.  Y.,  1907,  i,  p.  xv-xxxiv. 

Osier,  W.,  &  Churchman,  J.  W.    Syphilis. 
In:  Mod.  Med.  (Osier),  Phila.  &  N.  Y.,  1907,  iii,  436-521. 

Osier,  W.,  &  McCrae,  T.,  eds.  Modern  medicine,  its  theory  and 
practice.  In  original  contributions  by  American  and  foreign 
authors,    v.  1-3,  Phila.  &  N.  Y.,  1907,  Lea  Brothers  &  Co.    8°. 

Osier,  W.  [et  aZ.].  Discussion  on  the  diagnosis  of  acute  pan- 
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158  Sir  William  Osler,  Bart. 

Krehl,  Rudolf.  Principles  of  clinical  pathology.  A  text-book  for 
students  and  physicians.  Authorized  transl.  from  the  4.  Ger- 
man ed.  by  Walter  Hewlett,  with  an  introduction  by  William 
Osier.  2.  ed.  Phila.  &  Lond.  1907.  J.  B.  Lippincott  Co. 
520  p.     8°. 

Quarterly  (The)  Journal  of  Medicine.  Edited  by  William  Osier 
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1908 

Thomas  Linacre.  Cambridge,  1908,  University  Press,  64  p.  11  pi. 
12°. 

An  Alabama  student,  and  other  biographical  essays.  N.  Y.,  1908, 
Oxford  Univ.  Press,  Am.  Branch.    334  p.    8°. 

La  pratique  de  la  medecine.  Traduction  frangaise  sur  la  6®  edition 
par  M.  Solomon  et  Louis  Lazard.  Preface  du  Dr.  Pierre  Marie. 
Par.,  1908,  G.  Steinheil.    1230  p.    8°. 

On  multiple  hereditary  telangiectasis  with  recurring  haemorrhages. 
Quart.  J.  Med.,  Oxford,  1907-8,  i,  53-58. 

Splenic  polycythsemia  with  cyanosis.  Proc.  Roy.  Soc.  Med.,  Lond,, 
1907-8,  i,  Clin.  Sept.,  41-43. 

A  clinical  lecture  on  erythema  (polycythemia  with  cyanosis, 
maladie  de  Vaquez).    Lancet,  Lond.,  1908,  i,  143-146. 

Note  on  French  and  German  for  medical  students.  Lancet,  Lond., 
1908,  ii,  957. 

Splenic  enlargements  other  than  leukaemic.  Brit.  M.  J.,  Lond., 
1908,  ii,  1151-1154. 

Remarks  on  the  functions  of  an  out-patient  department.     Brit. 
M.  J.,  Lond.,  1908,  i,  1470-1473. 
Also:  St.  Louis  M.  Rev.,  1908,  Iviii,  344-346. 

Chronic  infectious  endocarditis.     Quart.  J.  Med.,  Oxford,  1908-9, 
ii,  219-230. 
Also:   Tribune  med.,  N.  Y.,  1909,  i,  v,  29. 

Endocardites  infectieuses  chroniques.    Bull,  et  mem.  Soc.  med.  d. 
hop.  de  Par.,  1908,  3.  s.,  xxv,  794-796. 
Also:  Tribune  med.,  Par.,  1908,  n.  s.,  xl,  773. 

The  pneumococcus  infections.    Clin.  J.,  Lond.,  1907-8,  xxxi,  295-301. 
Also:  Tr.  M.  Soc,  Lond.,  1909,  xxxi,  93-116. 

Historical  note  on  hereditary  chorea.  Neurographs,  Brooklyn, 
1908,  i,  113-116. 

Vienna  after  thirty-four  years.  J.  Am.  M.  Ass.,  Chicago,  1908, 
1,  1523-1525. 

Acute  endocarditis 

In:  Mod.  Med.  (Osier),  Phila.  &  N.  Y.,  1908,  iv,  133-150. 

Diseases  of  the  arteries. 

In:  Mod.  Med.  (Osier),  Phila.  &  N.  Y.,  1908,  iv,  426-447. 

Aneurysm. 

In:  Mod.  Med.  (Osier),  Phila.  &  N.  Y.,  1908,  iv,  448-502. 


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1909 

The  principles  and  practice  of  medicine,  designed  for  the  use  of 
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Paralysis  of  the  left  recurrent  laryngeal  nerve  in  mitral-valve 
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Schorstein  lecture  on  syphilis  and  aneurysm.  Brit.  M.  J.,  Lond., 
1909,  ii,  1509-1514. 

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Osier,  W.,  &  Keith,  A.    Stokes-Adams  disease. 
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1910 

The  principles  and  practice  of  medicine,  transl.  by  Philip  B. 
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In  memoriam.  Dr.  John  Hewetson,  1867-1910.  Johns  Hopkins 
Hosp.  Bull.,  Bait,  1910,  xxi,  357. 

Michael  Servetus.    Johns  Hopkins  Hosp.  Bull.,  Bait,  1910,  xxi, 
1-11. 
Also  transl.:  Deutsche  Rev.,  Stuttg.  u.  Leipz.,  1909,  iv,  328-347. 

Certain  vasomotor,  sensory,  and  muscular  phenomena  associated 
with  cervical  rib.  Am.  J.  M.  Sc,  Phila.  &  N.  Y.,  1910,  cxxxix, 
469-472. 

The  Lumleian  lectures  on  angina  pectoris.  Lancet,  Lond.,  1910, 
i,  697;  839;  973. 

Female  haemophiliacs  and  de  novo  cases  of  haemophilia.  Lancet, 
Lond.,  1910,  i,  1226. 

The  faith  that  heals.    Brit.  M.  J.,  Lond.,  1910,  ii,  1470-1472. 

The  pupil  symptoms  in  thoracic  aneurysm:  a  clinical  lecture; 
Radcliffe  Infirmary.    Practitioner,  Lond.,  1910,  Ixxxiv,  417-422. 

Ueber  angina  pectoris.    Allg.  Wien.  med.  Ztg.,  1910,  Iv,  435. 

Greek  at  Oxford.    Nation,  N.  Y.,  1910,  xci,  544-545. 

Dr.  William  H.  Welch.    Am.  Mag.  N.  Y.,  1910,  Ixx,  456-459. 

Osier,  W.,  &  McCrae,  T.,  eds.  Modern  medicine,  its  theory  and 
practice.  In  original  contributions  by  American  and  foreign 
authors,    v.  7,  Phila.  &  N.  Y.,  1910,  Lea  &  Febiger,  969  p.    8°. 

1911 

Man's  redemption  of  man.    Am.  Mag.,  N.  Y.,  1910-11,  Ixxi,  246-252. 

Transient  attacks  of  aphasia  and  paralyses  in  states  of  high  blood 
pressure  and  arteriosclerosis.  Canad.  M.  Ass.  J.,  Toronto, 
1911,  i,  919-926. 

An  address  on  the  hospital  unit  in  university  work.  Lancet,  Lond., 
1911,  i,  211-213. 
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1910,  xviii,  178-189. 

Remarks  on  organization  in  the  profession.     Brit.  M.  J.,  Lond., 

1911,  i,  237-239. 

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The  pathological  institute  of  a  general  hospital.  Glasgow  M.  J., 
1911,  Ixxvi,  321-333. 

Sir  Astley  Coopejr's  case  of  ligature  of  the  abdominal  aorta.  Guy's 
Hosp.  Gaz.,  Lond.,  1911,  xxv,  277. 

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1912 

The  principles  and  practice  of  medicine.  8.  ed.,  rev.  with  the 
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A  Drake  monument.    Lancet-Clinic,  Cincin.,  1912,  cvii,  421. 

Dr.  Robert  Fletcher.    Bristol  M.-Chir.  J.,  1912,  xxx,  289-294,  port. 

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I.  Nicolaus  Steno.    Canad.  M.  Ass.  J.,  Toronto,  1912,  ii,  67-68. 

II.  Les   collections  artistiques   de  la  Faculte  de  Medecine   de 
Paris. 

Ibid.,  68-69. 

III.  Samuel  Wilkes. 
Ibid.,  70-71. 

IV.  Jean  Astruc  and  the  higher  criticism. 
Ibid.,  151-152. 

V.  Two  Frenchmen  on  laughter. 
Ibid.,  152-155. 

VI.  An  incident  in  the  life  of  Harvey. 
Ibid.,  246-247. 

VII.  Letters  of  Laennec. 
Ibid.,  247-248. 

VIII.  Dr.  Payne's  library. 
Ibid.,  248-249. 

IX.  The  funeral  of  Lord  Lister. 
Ibid.,  343-344. 

X.  Gui  Patin. 
Ibid.,  429-430. 

XL  George  Bodington. 
Ibid.,  526-527. 

XII.  Histoire  de  la  Charite. 
Ibid.,  527-528. 

XIII.  The  school  of  Physic,  Dublin. 
Ibid.,  833-835. 

XIV.  Kelly's  American  Medical  Biography. 
Ibid.,  938-939. 

XV.  The  works  of  John  Caius. 
Ibid.,  1034-1036. 

XVI.  William  Beaumont. 
Ibid.,  1136-1138. 


162  Sir  William  Oslee,  Bart. 

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1913 

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Charles  Francis  Adams  at  Oxford.  Nation,  N.  Y.,  1913,  xcvii, 
503-504. 

Address  on  examinations,  examiners  and  examinees.    Brit.  M.  J., 
Lond.,  1913,  ii,  946-948. 
Also:   Lancet,  Lond.,  1913,  ii,  1047-1050. 
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An  arterio-venous  aneurysm  of  the  axillary  vessels  of  30  years' 
duration.    Lancet,  Lond.,  1913,  ii,  1248. 

Specialism  in  the  general  hospital.     Johns  Hopkins  Hosp.  Bull., 
Bait.,  1913,  xxiv,  167-171. 
Also:  Johns  Hopkins  Alumni  Mag.,  Bait,  1913,  i,  275-286. 

Case  illustrating  circulatory  disturbance  with  cervical  rib.  Proc. 
Roy.  Soc.  Med.,  Lond.,  1912-13,  vi,  Clin.  Sect.  9-12. 

[Introductory  remarks  on  history  of  medicine.]  Med.  Mag.,  Lond., 
1913,  xxii,  35. 

A  down  survey  manuscript  of  William  Petty.    Med.  Mag.,  Lona., 
1913,  xxii,  36-39. 
Also:  Proc.  Roy.  Soc.  Med.,  Lond.,  1912-13,  vi,  Sect.  Hist.  Med., 
2-5. 

Presidential  address,  British  Hospitals  Association.  Med.  Mag., 
Lond.,  1913,  xxii,  368-372. 

Men  and  books: 

XVII.  The  young  Laennec.     Canad.  M.  Ass.  J.,  Toronto,  1913, 
iii,  137-140. 

XVIII.  Mediaeval  Medicine. 
lUd.,  140-141. 

XIX.  Robert  Fletcher. 
lUa.,  227-228. 

XX.  Jaques  Benigne  Winslow. 
Ibid.,  319-321. 

XXI.  Aristotle,  Greek  Thinkers  by  Gemperz,  vol.  iv. 
IMd.,  416-417. 

XXII.  Dr.  Slop. 
IMd.,  612-613. 

XXIII.  John  Shaw  Billings. 
Ibid.,  613-616. 


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1914 

Bacilli  and  bullets.    N.  Y.,  1914,  Oxford  Univ.,  8  p.    12°. 

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Men  and  books: 

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XXVI.  Nathan  Smith. 
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An  address  on  the  medical  clinic;  a  retrospect  and  a  forecast. 
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Water  Hospital,  Bath.    Brit  M.  J.,  Lond.,  1914,  i,  1314-1315. 
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at  Churn.    Brit.  M.  J.,  Lond.,  1914,  ii,  569-570. 
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164  Sir  William  Osler,  Bart. 

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1915 

Science  and  war.    Oxford,  1915,  Clarendon  Press,  40  p.    8°. 

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Oct.  1,  1915.    7  p.     8°.     (Privately  printed.) 

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Special  discussion  on  the  epidemiology  of  cerebrospinal  meningitis. 
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The  Jonathan  Hutchinson  iconography.  A  preliminary  note. 
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Remarks  on  the  diagnosis  of  polycystic  kidney.  Internat.  Clin., 
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The  coming  age  of  internal  medicine  in  America.  Internat. 
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955. 

Note  on  acute  infectious  jaundice.    Lancet,  Lond.,  1915,  ii,  605. 

An  address  on  science  and  war.  Delivered  at  the  University  of 
Leeds  Medical  School  on  October  1,  1915.  Lancet,  Lond.,  1915, 
ii,  795-801. 

Cold-bite  +  muscle-inertia  =  trench-foot.  Lancet,  Lond.,  1915,  ii, 
1368. 

Medical  notes  on  England  at  war.    J.  Am.  M.  Ass.,  Chicago,  1915, 
Ixiv,  679-680;    1512-1513;   2001-2002. 
Also:  West  Canada  M.  J.,  Winnipeg,  1915,  ix,  59-65. 
Also:  Dominion  M.  Month.,  1915,  xliv,  41;  12b. 

Remarks  on  cerebrospinal  fever  in  camps  and  barracks.  Brit. 
M.  J.,  Lond.,  1915,  i,  189. 

Discussion  on  the  treatment  of  cerebrospinal  meningitis.  Brit. 
M.  J.,  Lond.,  1915,  ii,  604. 


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Aneurism. 
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Raynaud's  disease. 

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Angioneurotic  oedema,     Quincke's  disease. 

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Diffuse  scleroderma.     Erythromelalgia. 

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Osier,  Sir  W.  &  Gibson,  A.  G.    Diseases  of  the  valves  of  the  heart. 
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Osier,  Sir  W.  &  McCrae,  T.,  eds.  Modern  medicine,  its  theory  and 
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Macmichael,  William,  The  gold-headed  cane;  with  an  introduction 
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1915,  P.  M.  Hoeber,  261  p.     8°. 

1916 

Science  and  war;  an  address  delivered  at  the  University  of  Leeds 
Medical  School.    N.  Y.,  1916,  Oxford  Univ.  Press,  39  p.    8°. 

Intensive  work  in  science  at  the  public  schools  in  relation  to  the 
medical  curriculum.  School  World,  Lond.,  1916,  Feb.,  pp.  41-44. 
Also:   World's  Work,  Lond.,  1916,  Apr.,  pp.  434-438. 
Also  [Abstr.]:    Nature,  Lond.,  1915-16,  xcvi,  554-555. 

Illustrations  of  the  bookworm.  Bodleian  Quart.  Rec,  Oxford, 
1914-16,  i,  355-357. 

Creators,  transmuters  and  transmitters.  As  illustrated  by  Shakes- 
peare, Bacon  and  Burton.  Remarks  made  at  the  opening  of 
the  Bodley  Shakespeare  Exhibition,  April  24,   1916.     Lond., 

1916,  Oxford  Press,  8  p.     12°.     (Privately  printed.) 

Discussion  on  paratyphoid  fever.  Proc.  Roy.  Soc.  Med.,  Lond., 
1915-16,  ix,  Med.  Sect,  38. 

An  address  on  the  tuberculous  soldier.  Lancet,  Lond.,  1916,  ii, 
220-221. 

Local  tetanus  (Correspondence).   Lancet,  Lond.,  1916,  ii,  877. 

Osier,  Sir  W.,  Brown,  W.  L.,  \et.  al.^  Discussion  on  trench  nephri- 
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166  Sir  William  Osler,  Bart. 

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Osier,  Sir  W.,  Rolleston,  H.  D.,  [et.  al.]  Treatment  of  cerebro- 
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1917 

The  campaign   against  syphilis.     Delivered  before  the  Medical 
Society  of  London.     May  14,  1917.     Lancet,  Lond.,   1917,   i, 
787-792. 
Also:   Brit.  M.  J.,  Lond.,  1917,  i,  694-696. 

The  anti-venereal  campaign.     Annual  oration  of  the  Medical  So- 
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[Same  as:  "The  campaign  against  syphilis."] 

The  library  school  in  the  college.  An  address  at  the  opening  of 
the  summer  School  of  Library  Science,  Aberystwyth,  July  31, 

1917.  Library  Ass.  Rec,  Lond.,  1917,  xix,  287-308. 

The  "  Anatomic  universelle  "  of  Ambroise  Pare  (Editorial).  Ann. 
Med.  Hist.,  N.  Y.,  1917,  i,  424. 

The  problem  of  the  crippled.    Recalled  to  Life,  Lond.,  1917,  i,  265. 

The  problem  of  the  crippled  and  the  maimed.  Am.  J.  Care 
Cripples,  N.  Y.,  1917,  v,  243. 

War  wastage :  a  note  of  warning  to  examiners  of  recruits.  J.  Am. 
M.  Ass.,  Chicago,  1917,  Ixix,  290. 

Recurrence  or  redeposit  of  cancer?    Brit.  M.  J.,  Lond.,  1917,  i,  455. 

Home-bred  malaria  (Correspondence).  Lancet,  Lond.,  1917,  ii,  621. 

Viets,  H.  A  patronal  festival  for  Thomas  Willis  (1621-1675)  with 
remarks  by  Sir  William  Osier,  Bart.,  P.  R.  S.  Ann.  Med.  Hist., 
N.  Y.,  1917,  i,  118-124. 

1918 

Essai  de  bibliographic  hippique.  Edinburgh  &  Lond.,  1918,  W. 
Green  &  Son,  4  p.    8°. 

The  science  of  librarianship.  Bull.  Med.  Library,  Ass.  Bait.,  1917, 
18,  vii,  70-74. 

Typhoid  spine.    Bull.  Canadian  Army  M.  Corps,  1918,  i,  78-79. 

Graduated  exercise  in  prognosis.    Lancet,  Lond.,  1918,  i,  231. 

The  primary  examination  for  the  P.  R.  C.  S.  Eng. :  An  appeal  to 
the  President  of  the  Royal  College  of  Surgeons.  Lancet,  Lond., 

1918,  i,  715. 

Medicine  in  America  (Speech  to  University  Extension  Students, 
summer  meeting  at  Cambridge).  The  Hospital,  Lond.,  1918, 
Ixiv,  433. 

Trench  fever:  a  critical  analysis  of  the  report  of  the  American 
Commission.     Lancet,  Lond.,  1918,  ii,  496-499. 


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1919 

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Note. — Messrs.  Constable  &  Company  have  published  later  im- 
pressions of  "Man's  redemption  of  man"  (1918);  "A  way  of 
life"   (1918);   and  "Science  and  immortality"   (1906  and  1918). 


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